INCREASED BLOOD-STREAM INFECTION-RATES IN SURGICAL PATIENTS ASSOCIATED WITH VARIATION FROM RECOMMENDED USE AND CARE FOLLOWING IMPLEMENTATION OF A NEEDLELESS DEVICE

OBJECTIVE: To determine if an apparent increase in bloodstream infecti ons (BSIs) in patients with central venous catheters (CVCs) was associ ated with the implementation of a needleless access device. DESIGN: Re trospective cohort study using a derived CVC-days factor for estimatin g appropriate denominator data. SETTING: A 350-bed urban, acute, terti ary-care hospital. METHODS: BSI surveillance data were obtained, and h igh-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conduct ed to compare BSI rates before and during needleless device use. A sur vey 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-ris k units. Using existing surveillance BSI data and the estimated CVC da ys, 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 th at 60% to 70% were maintaining the needleless devices correctly. CONCL USION: We observed a significant increase in the BSI rate in two surgi cal 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 de vice, and needless-device use and care practices different from the ma nufacturer's recommendations.