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Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007

Published online by Cambridge University Press:  02 January 2015

Petra Wiersma ,
Sarah Schillie ,
Harry Keyserling ,
J. Renee Watson ,
Anindya De ,
Shailendra N. Banerjee ,
Cherie L. Drenzek ,
Kathryn E. Arnold ,
Christina Shivers  and
Lea Kendrick
...Show all authors
Petra Wiersma*
Affiliation:
Epidemic Intelligence Service, Atlanta, Georgia Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Sarah Schillie
Affiliation:
Epidemic Intelligence Service, Atlanta, Georgia
Harry Keyserling
Affiliation:
Centers for Disease Control and Prevention, the Emory University School of Medicine, Atlanta, Georgia
J. Renee Watson
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Anindya De
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Shailendra N. Banerjee
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Cherie L. Drenzek
Affiliation:
Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Kathryn E. Arnold
Affiliation:
Georgia Department of Human Resources, Division of Public Health, Atlanta, Georgia
Christina Shivers
Affiliation:
Epidemiology Elective Program, Atlanta, Georgia
Lea Kendrick
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Lydia Gonzalez Ryan
Affiliation:
Children's Healthcare of Atlanta, Atlanta, Georgia
Bette Jensen
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Judith Noble-Wang
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Atlanta, Georgia
*
5120 Geneva Place, Dulles, VA 20189, (petra.wiersma@gmail.com)
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Abstract

Objective.

To identify risk factors for polymicrobial bloodstream infections (BSIs) in pediatric bone marrow transplant (BMT) outpatients attending a newly constructed clinic affiliated with a children's hospital.

Methods.

All 30 outpatients treated at a new BMT clinic during September 10-21, 2007, were enrolled in a cohort study. The investigation included interviews, medical records review, observations, and bacterial culture and molecular typing of patient and environmental isolates. Data were analyzed using exact conditional logistic regression.

Results.

Thirteen patients experienced BSIs caused by 16 different, predominantly gram-negative organisms. Presence of a tunneled catheter (odds ratio [OR], 19.9 [95% confidence interval {CI}, 2.4-∞), catheter access (OR, 13.7 [95% CI, 1.8-∞]), and flushing of a catheter with predrawn saline (OR, 12.9 [95% CI, 1.0-766.0]) were independently associated with BSI. The odds of experiencing a BSI increased by a factor of 16.8 with each additional injection of predrawn saline (95% CI, 1.8-827.0). Although no environmental source of pathogens was identified, interviews revealed breaches in recommended infection prevention practice and medication handling. Saline flush solutions were predrawn, and multiple doses were obtained from single-dose preservative-free vials to avoid delays in patient care.

Conclusion.

We speculate that infection prevention challenges in the new clinic, combined with successive needle punctures of vials, facilitated extrinsic contamination and transmission of healthcare-associated pathogens. We recommend that preservative-free single-use vials not be punctured more than once. Use of single-use prefilled saline syringes might prevent multiuse of single-use saline vials. Storage of saline outside a medication supply system might be advisable. Before opening new clinic facilities, hospitals should consider conducting a mock patient flow exercise to identify infection control challenges.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 522 - 527
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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