Le. Danzig et al., BLOOD-STREAM INFECTIONS ASSOCIATED WITH A NEEDLELESS INTRAVENOUS-INFUSION SYSTEM IN PATIENTS RECEIVING HOME INFUSION THERAPY, JAMA, the journal of the American Medical Association, 273(23), 1995, pp. 1862-1864
Objective.- To determine risk factors for bloodstream infections (BSIs
) in an outbreak among patients receiving home intravenous infusion th
erapy. Design.- Case-control and retrospective cohort studies. Setting
- Home health agency. Patients.- Patients receiving home intravenous
infusion therapy from Rhode Island Home Therapeutics (RIHT) from Janua
ry through December 1993. Main Outcome Measure.- Development of primar
y BSI. Methods.- We compared patients with BSI (ie, case patients) wit
h randomly selected noninfected RIHT patients receiving intravenous th
erapy, conducted a cohort study of all RIHT patients receiving intrave
nous therapy via a central venous catheter (CVC), and conducted a cult
ure survey of injection cap luminal fluid. Results.- Case patients wer
e more likely than controls to have had therapy via a CVC (11/11 vs 14
/32; odds ratio [OR] undefined; P<.001) or total parenteral nutrition
and intralipid therapy (TPN/IL) (9/11 vs 3/32; OR, 43.5; 95% confidenc
e interval [CI], 4.9 to 510.0). Among RIHT patients with CVCs, risk fa
ctors for BSI were receipt of TPN/IL (9/35 vs 2/67; rate ratio [RR], 8
.6; 95% CI, 2.0 to 37.7) or use of a needleless infusion system (10/41
vs 1/61; RR, 14.9; 95% CI, 2.0 to 111.8). Only the combination of bot
h exposures was significantly associated with development of a BSI (P<
.001). Luminal fluid from injection caps of needleless devices was sig
nificantly more likely to be culture positive than fluid from protecte
d-needle devices (5/23 vs 0/18; RR undefined; P=.04).Conclusions.- Our
data suggest that a needleless device used for TPN/IL was associated
with increased risk of BSI when injection caps were changed every 7 da
ys.