Impact on rates and time to first central vascular-associated bloodstream infection when switching from open to closed intravenous infusion containers in a hospital setting

Abstract

An open-label, prospective cohort, active healthcare-associated infection surveillance sequential study was conducted in four Italian intensive-care units. The aim was to determine the effect of switching from open (glass) to closed fully collapsible plastic intravenous (i.v.) infusion containers (Viaflo) on rate and time to onset of central venous catheter-associated bloodstream infections (CVC-BSI). A total of 1173 adult patients were enrolled. The CVC-BSI rate during the open container period was significantly higher than during the closed container period (8.2 vs. 3.5 BSI/1000 CVC days, relative risk 0.43, 95% confidence interval 0.22-0.84, P=0.01). The probability of developing a CVC-BSI was assessed over time comparing open and closed i.v. infusion containers. In the closed container period, it remained fairly constant (0.8% at days 1-3 to 1.4% at days 7-9) whereas during the open container period it increased (2% at days 1-3 to 5.8% at days 7-9). Overall, the chance of acquiring a CVC-BSI significantly decreased by 61% in the closed container period (Cox proportional hazard ratio 0.39, P=0.004).

Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

“…7,8,14 More recently, closed infusion containers have been shown to reduce the risk of central line-associated BSI compared with open systems. [15][16][17] Similarly, patients receiving premixed parenteral nutrition solutions have been shown to have a substantially reduced risk of BSI relative to those receiving traditionally compounded parenteral nutrition. 18 Whether or not other delivery systems that limit manual admixture of drug and solution have a beneficial impact on BSI rates has not been extensively examined.…”

Bloodstream Infections Associated With Parenteral Nutrition Preparation Methods in the United States

“…40 Sterile equipment, hand hygiene, aseptic technique, routine dressing changes, in-line filters, and skin disinfection are all recommended to minimize infection. 35,41 Although not specifically linked to PN delivery systems, closed systems in general have been associated with BSI reduction of at least 50% when compared to the use of an open system [42][43][44][45][46] and have demonstrated cost effectiveness. 47 Although our analysis reflects the real-world use of PN, it does have several important limitations.…”

Nutrition Therapy Cost Analysis in the US

“…Until now, data to distinguish between the method of PN preparation and its potential impact on BSI have not been available, although closed-intravenous systems (fully collapsible containers that do not use an external vent to empty the solution, with self-sealing injection ports), have consistently demonstrated significantly lower incidences of central venous catheter-associated bacteraemia than open systems. [35–38] The analysis presented here may provide a greater understanding of the factors that influence infection in PN patients.…”