PORT PROTECTORS AND EDUCATIONAL INTERVENTION: THE KEY TO ZERO CENTRAL LINE-‐ASSOCIATED BLOODSTREAM INFECTION – A RANDOMIZED CONTROLLED TRIAL
Inchingolo R, Magnini D, Montemurro G, Smargiassi A, Pasciuto G, Cavalletti M, Torelli R, Spanu T, Sanguinetti M, Scoppettuolo G, Pittiruti M, Valente S, Corbo GM
Catholic University Hospital, Rome, Italy.
Introduction
Catheter line associated bloodstream infection (CLABSI) are an important clinical issue, specially in critical ill patients and/or in immunosuppressed patients. The best prevention strategy against CLABSI is to
standardize care bundles.
Method
We planned a prospective randomized study to evaluate the efficacy of an educational intervention program with or without the introduction of a port protector (Curos, Invera Medical) on the rate of CLABSI. We enrolled patients of our Pulmonary Medicine Unit with central venous access devices (CVAD) placed in absence of fever and without microbiological evidence of colonization of previous CVAD. After a 9-‐month observation, physicians and nurses of the Unit received a proper education on strategies of CLABSI prevention. In the following 9 months, we randomized patients into two groups: 1) educational intervention plus consistent use of Curos (study group) and 2) educational intervention only (control group).
In case of suspected CLABSI, simultaneous peripheral and central blood cultures were performed, identifying 5 conditions: 1) catheter-‐related sepsis (both blood cultures positive, central positivity > 2h before peripheral); 2) catheter-‐unrelated sepsis (both blood cultures positive, peripheral positivity > 2h before central; 3) catheter colonization (central positivity only); 4) peripheral blood culture contamination (peripheral positivity only); 5) both blood cultures negative.
Results
During 9-‐month observation, we studied 87 CVAD (1068 cath.days) ; we detected 9 CLABSI (8.4/1000 cath.days), 16 catheter colonizations and 6 blood culture contaminations. During the 9-‐month interventional period, we studied 46 CVAD (21 in the study group, 25 in controls: 707 cath.days); we detected only one CLABSI (in the control group: 1.4/1000 cath.days), 5 catheter colonizations (2 in the study group, 4 in controls) and 3 contaminations of blood cultures (only in controls).
Discussion & Conclusion
Our study shows that both kinds of interventions significantly reduce the rate of CLABSIs. In particular, the use of Curos combined to educational intervention was associated with zero CLABSI.
