The effect of dual policy interventions on the rate of central venous catheter associated infections in adult stem cell transplant patients with hematological malignancy in Newfoundland and Labrador

Dunne, Tom (2021) The effect of dual policy interventions on the rate of central venous catheter associated infections in adult stem cell transplant patients with hematological malignancy in Newfoundland and Labrador. Masters thesis, Memorial University of Newfoundland.

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Abstract

Background: Central venous catheters (CVCs) have a risk of infectious complications. With a suspected rise in cases in stem cell transplants, Eastern Health implemented two changes to reduce infections in June 2018: (1) earlier CVC insertion and (2) restriction of CVC access to specially trained nurses. The primary outcome was the difference in rate of CVC-associated infections per 1,000 catheter-days. Secondary outcomes included identifying modifiable risk factors to target for future clinical interventions to lower complication rates. Methods: This single-centre observational before-and-after study included adult SCT patients with CVCs was divided into the pre- and post-intervention cohorts between 2014-2020. A complete chart review was conducted from the period of first CVC insertion through the endpoint of CVC removal or patient death to identify all incident cases of CVC associated infection, risk factors, cultures and 90-day all-cause mortality. Results: The study demonstrated an incidence of catheter-related bloodstream infections (CR-BSI) of 21.3% in the pre-intervention group and 25.0% in the postintervention group (p=0.681). CR-BSI per 1000 catheter-days was similarly 2.39 and 3.39 (p=0.628). Neither was statistically significant. The study identified a novel risk factor in preceding history of bacteremia (HR 763.1, p=0.039). In conclusion we were unable to demonstrate a reduction in infectious complications associated with the two interventions.

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