Impact of Addition of Alcohol-Impregnated Port Protectors to Post Central Line Insertion Bundle in the Adult Blood and Marrow Transplant Population

Topic Significance & Study Purpose/Background/Rationale 

Central venous catheters (CVC) are a commonly used tool in hematopoietic stem cell transplant (HSCT).  Several risks are associated with the use of CVCs including infection and thrombosis.  The incidence of blood stream infection in HSCT recipients has been observed at 13-60% (Dix, Yeung, Rule & Ma, 2011).  Poutsiaka et al. (2007) found that blood stream infection was independently associated with increased mortality after HSCT. On average a CLABSI increases a patient’s length of stay by 7.5 days and costs $16,550 to treat (Sacks et al., 2014). 

In NHSN's 2012 summary of device-associated infections, the median CLABSI rate for the more than 178 participating general hematology oncology facilities was 0.8 for permanent central lines and 1.2 for temporary central line catheters. The median was 1.3 and 2.4 for more than 54 participating hematopoietic stem cell transplant units.  OUMC’s CLABSI data does not differentiate between permanent and temporary central lines, but the CLABSI rates during the six month period control period were higher than the national median for the two types of lines combined.  Between July 1, 2013 and December 31, 2013, nine CLABSIs occurred in the Bone Marrow Transplant Unit; a CLABSI rate of 10.5/1,000 central line days.

Methods, Intervention, & Analysis 

An interdisciplinary team developed an intervention to reduce the number of CLABSIs in the Adult Blood and Marrow Transplant Unit, in addition to the standard central line maintenance bundle.

An observational pre-intervention/post-intervention trial was conducted in an adult blood and marrow transplant unit university-affiliated acute care teaching hospital.  During the intervention alcohol-impregnated port protectors were used in the place of alcohol wipes for hub care.  The intervention period was compared with a historical control.

Findings & Interpretation 

A total of 466 central line days and 1 CLABSI were documented during the intervention period, compared with 762 central line days and 9 CLABSIs during the control period.

Discussion & Implications 

The addition of alcohol-impregnated port protectors to central line maintenance can assist in reduction of CLASBI incidence in the blood and marrow transplant population, which should reduce the morbidity and mortality associated with infection in the immune-compromised patient.