Hospital readmissions for catheter-related bloodstream infection and use of ethanol lock therapy: comparison of patients receiving parenteral nutrition or intravenous fluids in the home vs a skilled nursing facility.
BACKGROUND
Catheter-related bloodstream infection (CRBSI) is the most serious long-term infectious complication of long-term home parenteral nutrition (PN). Ethanol is being used more commonly as a catheter locking solution in the home PN setting for prevention of CRBSI; however, no current literature reports the use of ethanol lock (ETL) in skilled nursing facility (SNF) patients.


METHODS
The authors evaluated the number of hospital readmissions for CRBSI and length of stay between SNF (not receiving ETL) and home patients (receiving or not receiving ETL) receiving PN or intravenous fluid therapy.


RESULTS
SNF patients had a significantly longer length of stay (LOS) for CRBSI hospital admissions compared with patients receiving PN at home with or without ETL (P < .001; 16 vs 8 vs 8 days). There was no LOS difference for CRBSI between home patients with or without ETL. Home PN patients not receiving ETL were more likely to have a CRBSI from Staphylococcus sp (48% vs 27%; P = .015), whereas SNF PN patients not receiving ETL were more likely to have a CRBSI from Enterococcus sp (16% vs 3%; P = .004).


CONCLUSIONS
Despite different causative organisms and medical acuity likely affecting the differences observed in LOS, the SNF population is another setting ETL can be used to prevent CRBSI.
Cleveland Clinic, Cleveland, Ohio 44195, USA. corrigm5@ccf.org
Mandy L
ML
Corrigan
Cassandra
C
Pogatschnik
Denise
D
Konrad
Donald F
DF
Kirby
D016470:Bacteremia / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D016983:Enterococcus; D000431:Ethanol; D006699:Home Care Services; D006801:Humans; D007902:Length of Stay; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000379:methods; D010343:Patient Admission; D010359:Patient Readmission; D012866:Skilled Nursing Facilities; D013210:Staphylococcus
D000431:Ethanol