2013 - ISBTS 2013 Symposium

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Mini-Oral Communications 1

12.240 - Ethanol locks decrease catheter related bloodstream infection (CRBSI) admissions in home parenteral nutrition (HPN) patients

Presenter: Koji, Hashimoto, , United States
Authors: Ezra Steiger¹, Denise Konrad¹, Rocio Lopez¹, Rex Speerhas¹, Abdullah Shatnawei¹, Karen Giaco¹, Donald Kirby¹

Ethanol locks decrease catheter related bloodstream infection (CRBSI) admissions in home parenteral nutrition (HPN) patients

Ezra Steiger¹, Denise Konrad¹, Rocio Lopez¹, Rex Speerhas¹, Abdullah Shatnawei¹, Karen Giaco¹, Donald Kirby¹

¹Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States

Introduction

Catheter related bloodstream infections (CRBSI) necessitate hospital readmissions and is a potential indication, if recurrent or severe, for small intestinal transplantation. We present our experience using ethanol locks to prevent tunneled cuffed catheter infections in HPN patients

Materials and Methods

A prospective clinical management database is maintained by the Nutrition Support Team for the management of patients on HPN at the Cleveland Clinic. Readmissions and reasons for readmission to the hospital are entered into the system and maintained for quality assurance purposes as well as patient management. We have recently began using an ethanol lock system initially for those patients with recurrent CRBSI’s and most recently in 2012 for all patients discharged on HPN with a tunneled cuffed catheter. The database was queried regarding the use of ethanol locks and CRBSI’s from Jauary 2010 through February of 2013. A Poisson regression model was used to assess changes in CRBSI admission rates through the years.

Results

Use of EtOH lock and CRBSI rates in HPN patients
	2010	2011	2012	2013
Total patients active with HPN	330	342	442	272
Number of new patients discharged on HPN	193	197	273	40
Number of patients discharged with EtOH lock	71	58	190	26
Total CRBSI admissions	104	74	60	6
Total catheter days	47256	57245	74439	14802
% of new HPN pts dicharged with EtOH lock	36.8	29.4	69.6	65
CRBSI admissions per 1000 catheter days (95% CI)	2.20 (1.78, 2.62)	1.29 (1.00, 1.59)	0.81 (0.60, 1.01)	0.41 (0.08, 0.73)

Conclusion

The use of ethanol locks has been associated with a significant decrease in CRBSI’s (p<0.001) in our HPN patients

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