676. Comparison of a Novel Silver-Coated Catheter Access Device and a Standard Catheter Access Device: A Dual Center Cross-Over Study
Session: Poster Abstract Session: Preventing Catheter Associated Infections
Friday, October 21, 2011
Room: Poster Hall B1

Background: We compared a novel vascular access device (VAD) to a conventional VAD to assess impact on catheter-associated bloodstream infection (caBSI). 

 

Methods:  A crossover study in two university hospitals comparing a silver-coated VAD (Vlink, Baxter Healthcare) with a mechanically identical non-coated VAD (Clearlink, Baxter Healthcare) started in11/09 with hospitals switching VADs in 9/10; data collection after crossover will continue through 6/11. Central line-days for all patients were captured for final analysis using line-days as denominator; this preliminary analysis compares caBSI rates per 1000 patient-days. Attribution of a BSI to a catheter was done by a single blinded reviewer using NHSN definitions.  Analysis was done with and without inclusion of BSI in the setting of neutropenic fever (NF) because of discordant rates of NF at the two hospitals. caBSIs in patients with hemodialysis catheters were excluded (different VAD).  Incidence rates (IR) of caBSI per 1000 patient-days were estimated and compared using exact methods based on the Poisson distribution.  Poisson regression was used to calculate the effect of hospital and VAD on the outcome of caBSI.

Results:  The crude IR in patients with the silver-coated VAD (0.52/1000 patient-days) was lower compared to the standard VAD (0.76/1000 patient-days, p<0.01).  Excluding patients with NF, the IRs in the silver and standard VAD were 0.44/1000 patient-days and 0.58/1000 patient days, respectively (p=0.07). In hospital A, the IR with the silver VAD was 0.39 /1000 patient-days (95% confidence interval [CI]: 0.28-0.55) before crossover and 0.53/1000 patient-days (95% CI: 0.37-0.76) after. In hospital B, the IR with the standard VAD was 0.87/1000 patient-days (95% CI: 0.72-1.05) before crossover and 0.67/1000 patient-days (95% CI: 0.51-0.89) after (figure).  Using multivariate analysis, hospital (p<0.01) but not VAD (p=0.06) was a predictor of caBSI.

Conclusion: In this interim analysis, we observed lower crude caBSI rates per 1000 patient-day using the novel silver VAD. When controlled for hospital, the reduction in caBSI using the novel VAD did not reach statistical significance (p=0.06). Final analysis will use the endpoint of caBSI rates per 1000 line-days.



Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Jesse Jacob, MD1, Sheri Chernetsky Tejedor, MD1, Mary Dent Reyes, MPH1, Jeffrey Switchenko, MS2, Kirk Easley, MS2, Gina Garrett, RN3, Kimberly Graham, RN3, Carolyn Holder, RN3, Chad Robichaux, BA3 and James Steinberg, MD1, (1)Emory University School of Medicine, Atlanta, GA, (2)Emory University School of Public Health, Atlanta, GA, (3)Emory Healthcare, Atlanta, GA

Disclosures:

J. Jacob, Baxter Healthcare: Grant Investigator, Grant recipient

S. Chernetsky Tejedor, Baxter Healthcare: Grant Investigator, Research grant

M. Dent Reyes, None

J. Switchenko, None

K. Easley, None

G. Garrett, None

K. Graham, None

C. Holder, None

C. Robichaux, None

J. Steinberg, Baxter Healthcare: Grant Investigator, Research grant

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.