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OBJECTIVE In this study, we examined the impact of routine use of a passive disinfection cap for catheter hub decontamination in hematology–oncology patients. SETTING A tertiary care cancer center in New York City METHODS In this multiphase prospective study, we used 2 preintervention phases (P1 and P2) to establish surveillance and baseline rates followed by sequential introduction of disinfection caps on high-risk units (HRUs: hematologic malignancy wards, hematopoietic stem cell transplant units and intensive care units) (P3) and general oncology units (P4). Unit-specific and hospital-wide hospital-acquired central-line–associated bloodstream infection (HA-CLABSI) rates and blood culture contamination (BCC) with coagulase negative staphylococci (CONS) were measured. RESULTS Implementation of a passive disinfection cap resulted in a 34% decrease in hospital-wide HA-CLABSI rates (combined P1 and P2 baseline rate of 2.66–1.75 per 1,000 catheter days at the end of the study period). This reduction occurred only among high-risk patients and not among general oncology patients. In addition, the use of the passive disinfection cap resulted in decreases of 63% (HRUs) and 51% (general oncology units) in blood culture contamination, with an estimated reduction of 242 BCCs with CONS. The reductions in HA-CLABSI and BCC correspond to an estimated annual savings of $3.2 million in direct medical costs. CONCLUSION Routine use of disinfection caps is associated with decreased HA-CLABSI rates among high-risk hematology oncology patients and a reduction in blood culture contamination among all oncology patients.

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Background Allogeneic hematopoietic stem cell transplant (HSCT) recipients are at high risk for developing C. difficile infection (CDI). We studied the incidence, risk factors, NAP1/027 prevalence, and clinical outcomes including acute lower gastrointestinal graft versus host disease (GI GVHD) associated with early CDI in this population. Methods Retrospective review of patients who underwent allogeneic HSCT at MSKCC from January 1, 2005 – September 30, 2010. Early CDI was defined as infection occurring from day −10 to +40 from stem cell infusion. Results Among 793 patients who received allogeneic HSCTs, early CDI occurred in 11.9%; 56% cases were between day −5 to +5. Overall incidence was 25.2 cases/10,000 at risk days. There was a high prevalence of NAP1/027 strains during peak incidence (61% in 2008). NAP1/027 was the most common strain in both adults and pediatric cases (24 and 23 % respectively). CDI was clinically mild, including those due to NAP1/027. Metronidazole was the primary treatment for 91/94 patients, 7/8 cases refractory to metronidazole had no response to vancomycin; none were due to NAP1/027. Relapse of CDI was common (31%). The cumulative incidence of GI GVHD in patients with and without early CDI was 6.8% and 8.% respectively (p=0.5). Conclusion The majority of cases of CDI occurred during conditioning or immediately after transplant. Despite high prevalence of NAP 1/027, we found only mild disease. Most patients were treated successfully with metronidazole, irrespective of NAP-1/027 status. There was no significant association between early CDI and subsequent development of GI GVHD.

These data suggest that evodiamine shows anticancer activity through inhibition of tubulin polymerization. This antitubulin activity might make evodiamine a potential anticancer drug.