![[ Visit SHEA online ]](images/banner.gif)
Background: Central venous catheters are frequently used for home-based infusion therapies. CLABSIs in the outpatient setting are associated with significant morbidity, mortality, and cost. Addressing CLABSIs is challenging in this setting because the home environment is often unpredictable and the patient often administers infusions and assumes responsibility for line care. Unfortunately, few data on interventions to decrease rates of CLABSIs in the home infusion population exist.
Objective: To present our experience with instituting a comprehensive multidisciplinary strategy to decrease CLABSIs in the home infusion population.
Methods: We implemented a multidisciplinary strategy as follows: 1) July 2008-September 2008: introduction of chlorhexidine-impregnated sponge use; 2) August 2008-December 2009: institution of a multifaceted patient and staff education project including hand hygiene, respiratory hygiene, line care, dressing change procedures, lab draw procedures, and strategies to avoid and/or address situations in daily life that could compromise sterility; 3) June 2010-September 2010: prior to summer months, additional dressing materials, including sterile breathable adhesive dressings with nonadhesive absorbent pads. Baseline demographic characteristics and types of infections were assessed before, during, and after the intervention period. Given the multiple sequential interventions, results are presented descriptively.
Results: Prior to interventions, the rate of bloodstream infections was 1.48 per 1000 therapy days. Over the entire study period, there were a total of 174 patients with CLABSIs with a total of 195 organisms, of which 53.8% were gram-negative bacteria, 35.9% were gram-positive bacteria, and 10.3% were fungi. Of all CLABSIs, the patient's primary diagnosis was: 60.3% malignancy, 28.7% gastrointestinal tract disorder, 7.4% infection, and 3.6% other diseases. In terms of primary therapy, 42.0% of infections were in patients receiving TPN, 29.9% were in patients receiving no therapy but catheter care, 12.1% were in patients receiving hydration, 10.3% were in patients receiving antimicrobials, and 5.7% were in patients receiving other therapy. There appeared to be a seasonal variation in rates of infections (figure), with the highest frequency of CLABSIs occurring in summer months. The rate of bloodstream infections decreased from 1.48 in June of 2008 to 0.21 in August of 2010. This rate is even more notable because it occurred in August, traditionally one of the months with the highest infection rates.
Conclusions: Standardizing line care and teaching patients infection prevention strategies applicable to the home infusion environment is effective at decreasing CLABSIs, but doing so requires a sustained and multidisciplinary approach.
