caa a22 4500 388034602 CHVBK 20180307125000.0 cr unu---uuuuu 161130e199801 xx s 000 0 eng 10.1086/647702 doi S0195941700000084 pii (NATIONALLICENCE)cambridge-10.1086/647702 Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care Following Implementation of a Needleless Device [Elektronische Daten] Abstract Objective: To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device. Design: Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data. Setting: A 350-bed urban, acute, tertiary-care hospital. Methods: BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices. Results: The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly. Conclusion: We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations. Copyright © The Society for Healthcare Epidemiology of America 1998 Cookson Susan Temporado Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana Ihrig Melanie Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana O'Mara Edward M. Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana Denny Mark Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana Volk Helen Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana Banerjee Shailen N. Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana Hartstein Alan I. Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana Jarvis William R. Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana Infection Control & Hospital Epidemiology Cambridge University Press 19/1(1998-01), 23-27 0899-823X 19:1<23 1998 19 ICE https://doi.org/10.1086/647702 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1086/647702 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Cookson Susan Temporado Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Ihrig Melanie Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- O'Mara Edward M. Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Denny Mark Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Volk Helen Department of Medicine, Indianapolis, Indiana; the Department of Infection Control/Epidemiology, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Banerjee Shailen N. Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Hartstein Alan I. Centers for Disease Control and Prevention, Atlanta, Georgia, the Division of Infectious Diseases, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 700 1- Jarvis William R. Hospital Infections Program, Indiana University Medical Center, Indianapolis, Indiana NATIONALLICENCE 773 0- Infection Control & Hospital Epidemiology Cambridge University Press 19/1(1998-01), 23-27 0899-823X 19:1<23 1998 19 ICE CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge