BLOOD-STREAM INFECTIONS IN-HOME INFUSION PATIENTS - THE INFLUENCE OF RACE AND NEEDLELESS INTRAVASCULAR ACCESS DEVICES

Objectives: To determine the cause of increased central venous cathete r-associated (CVC) bloodstream infection (BSI) rates in a cohort of pe diatric hematology/oncology patients receiving home health care (HHC). Methods: A retrospective cohort study of hematology/oncology patients with CVCs receiving HHC from January 1992 through November 1994. Resu lts: Of 182 patients with CVCs identified during the study period, 58 (32%) acquired 90 BSIs during 75,085 CVC days. BSI rates increased sig nificantly from 1992 through 1994 (0.8 vs 1,0 vs 1.7 BSIs per 1000 CVC days; p <0.005), Known risk factors, including catheter type, patient age less than 5 years, sex, or diagnosis, were not associated with in creased BSI rates. After introduction of needleless devices for CVC ac cess to the HHC regimen in May 1993, BSI rates increased 80% (from 0.8 1 to 1,46 BSIs/1000 CVC days, relative risk 1,8; p <0.02). The only ot her significant risk factor was the race of the patient. White childre n had the lowest BSI rate before and after needleless-device introduct ion (0.4 vs 0.9 BSIs/1000 CVC days; p >0.1), whereas black patients ha d the highest, unaffected by the introduction of these devices (2.5 BS Is/1000 CVC days). Both Hispanic (0.5 vs 1.6 BSIs/1000 CVC days) and A sian-American children's (0.4 vs 1.5 BSIs/1000 CVC days) BSI rates inc reased threefold and fourfold after the introduction of needleless dev ices. Conclusions: Our data suggest that pediatric hematology/oncology patients receiving HHC via needleless devices may have an increased r isk of BSIs, and this risk may vary by race. We hypothesize that preve ntion of BSIs may require consideration of cultural, ethnic, and langu age differences when parents are trained to provide care for their chi ldren with CVCs in the home.