Comparison of the Infectious Risk of Catheter Related Blood Stream Infection Between a Split Septum and Mechanical Valve in Pediatric Oncology Inpatients

Background: Central Venous Catheter (CVC) is essential for administration of anticancer drug and total parental nutrition and for blood sampling in pediatric oncology patients. Needleless connectors are important component of the intravenous systems. After split septum needleless connectors (SS-NC) was converted to mechanical valve needleless connectors (MV-NC) to minimize the risk of sharps injury in our hospital, the number of patients of catheter related blood stream infection (CRBSI) drastically increased. To compare the risk of CRBSI between both connector systems, we conducted epidemiological investigations.

Methods: We investigated all oncology patients who had tunneled CVC in our pediatric ward from April 2015 to March 2016. We retrospectively assessed the association between the types of needleless connectors and the incidence rate of CRBSI in three periods: the first period during which SS-NC was used (period 1, 92 days), the second period during which MV-NC was used (period 2, 45 days), and the third period during which SS-NC was used again instead of MV-NC (period 3, 167 days).

Results: Forty-five (a cumulative total of 80) patients were included in this study, period 1, 23: period 2, 22: period 3, 35. The incidence rate of CRBSI in period 2 significantly increased than in period 1 (1.8 vs 12.3 per 1,000 catheter days; relative risk, 2.7; 95% confidence interval, 1.9 to 3.8; P < 0.01), while that in period 3 significantly decreased than that period 2 (12.3 vs 0.9 per 1,000 catheter-days; RR, 0.29; 95% CI, 0.11 to 0.78; P < 0.01). Staphylococcus epidermidis was the most causative organism of CRBSI (60%), followed by Enterococcus spp(13%) and Micrococcus spp(13%). There are no changes in the process of insertion and handling of CVC during all periods.

Conclusion: Our results suggest the risk of CRBSI in catheter system with MV-NC is higher than that with SS-NC. SS-NC might be employed instead of MV-NC in pediatric oncology wards.