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Environmental Exposures and the Risk of Central Venous Catheter Complications and Readmissions in Home Infusion Therapy Patients

Published online by Cambridge University Press:  04 October 2016

Sara C. Keller ,
Deborah Williams ,
Mitra Gavgani ,
David Hirsch ,
John Adamovich ,
Dawn Hohl ,
Amanda Krosche ,
Sara Cosgrove  and
Trish M. Perl
Sara C. Keller*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Deborah Williams
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Mitra Gavgani
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
David Hirsch
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
John Adamovich
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Dawn Hohl
Affiliation:
Johns Hopkins Home Care Group, Baltimore, Maryland.
Amanda Krosche
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Sara Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Address correspondence to Sara C. Keller, MD, MPH, MSHP, 10751 Falls Road, Suite 412, Lutherville, MD 21093 ([email protected]).
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Abstract

BACKGROUND

Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy.

OBJECTIVE

To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications.

DESIGN

Prospective cohort study between March and December 2015.

SETTING

Home infusion therapy after discharge from academic medical centers.

PARTICIPANTS

Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal.

METHODS

Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications.

RESULTS

Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications.

CONCLUSIONS

complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients.

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 68 - 75
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek 2015, San Diego, California, October 7–11, 2015, abstract 1454; the National Home Infusion Association Conference, New Orleans, Louisiana, March 21–24, 2016, abstract 2; the Translational Science Conference, Washington, DC, April 13–15 2016, abstract TMP123; and the Society of Healthcare Epidemiology of America Annual Conference, Atlanta, Georgia, May 18–21, 2016 abstract 7851.

S.C. and T.M.P. contributed equally to this article.

References

REFERENCES

1. Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.Google Scholar
2. Nathwani, D, Tice, A. Ambulatory antimicrobial use: the value of an outcomes registry. J Antimicrob Chemother 2002;49:149–154.CrossRefGoogle ScholarPubMed
3. National Home Infusion Association (NHIA). The NHIA industry-wide data initiative phase I: 2010 NHIA provider survey comprehensive aggregate analysis report. NHIA website. http://www.nhia.org/Data/phase1.cfm. Published 2016. Accessed May 10, 2016.Google Scholar
4. Association of Professionals in Infection Control (APIC). APIC-HICPAC surveillance definitions for home health care and home hospice infections. APIC website. http://www.apic.org/Resource_/TinyMceFileManager/Practice_Guidance/HH-Surv-Def.pdf. Published 2008. Accessed May 10, 2016.Google Scholar
5. Rinke, ML, Bundy, DG, Milstone, AM, et al. Bringing central line-associated bloodstream infection prevention home: CLABSI definitions and prevention policies in home health care agencies. Jt Comm J Qual Patient Saf 2013;39:361–370.Google ScholarPubMed
6. Shang, J, Ma, C, Poghosyan, L, Dowding, D, Stone, P. The prevalence of infections and patient risk factors in home health care: a systematic review. Am J Infect Control 2014;42:479–484.Google Scholar
7. Crispin, A, Thul, P, Arnold, D, Schild, S, Weimann, A. Central venous catheter complications during home parenteral nutrition: a prospective pilot study of 481 patients with more than 30,000 catheter days. Onkologie 2008;31:605–609.Google Scholar
8. John, BK, Khan, MA, Speerhas, R, et al. Ethanol lock therapy in reducing catheter-related bloodstream infections in adult home parenteral nutrition patients: results of a retrospective study. JPEN J Parenter Enteral Nutr 2012;36:603–610.CrossRefGoogle ScholarPubMed
9. Santarpia, L, Alfonsi, L, Tiseo, D, et al. Central venous catheter infections and antibiotic therapy during long-term home parenteral nutrition: an 11-year follow-up study. JPEN J Parenter Enteral Nutr 2010;34:254–262.CrossRefGoogle ScholarPubMed
10. Moureau, N, Poole, S, Murdock, MA, Gray, SM, Semba, CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol 2002;13:1009–1016.Google Scholar
11. Shirotani, N, Iino, T, Numata, K, Kameoka, S. Complications of central venous catheters in patients on home parenteral nutrition: an analysis of 68 patients over 16 years. Surg Today 2006;36:420–424.CrossRefGoogle ScholarPubMed
12. DeLegge, MH, Borak, G, Moore, N. Central venous access in the home parenteral nutrition population—you PICC. JPEN J Parenter Enteral Nutr 2005;29:425–428.Google Scholar
13. Ireton-Jones, C, DeLegge, M. Home parenteral nutrition registry: a five-year retrospective evaluation of outcomes of patients receiving home parenteral nutrition support. Nutrition 2005;21:156–160.Google Scholar
14. Reimund, JM, Arondel, Y, Finck, G, Zimmermann, F, Duclos, B, Baumann, R. Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey. Clin Nutr 2002;21:33–38.Google Scholar
15. Rosenheimer, L, Embry, FC, Sanford, J, Silver, SR. Infection surveillance in home care: device-related incidence rates. Am J Infect Control 1998;26:359–363.Google Scholar
16. Tokars, JI, Cookson, ST, McArthur, MA, Boyer, CL, McGeer, AJ, Jarvis, WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med 1999;131:340–347.Google Scholar
17. Buchman, AL, Opilla, M, Kwasny, M, Diamantidis, TG, Okamoto, R. Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2013;38:744–749.Google Scholar
18. O’Keefe, SJ, Burnes, JU, Thompson, RL. Recurrent sepsis in home parenteral nutrition patients: an analysis of risk factors. JPEN J Parenter Enteral Nutr 1994;18:256–263.Google Scholar
19. White, MC, Ragland, KE. Surveillance of intravenous catheter-related infections among home care clients. Am J Infect Control 1994;22:231–235.Google Scholar
20. Rinke, ML, Milstone, AM, Chen, AR, et al. Ambulatory pediatric oncology CLABSIs: epidemiology and risk factors. Pediatr Blood Cancer 2013;60:1882–1889.Google Scholar
21. Johansson, E, Bjorkholm, M, Bjorvell, H, et al. Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia—a randomized study. Support Care Cancer 2004;12:99–105.CrossRefGoogle ScholarPubMed
22. Greene, MT, Flanders, SA, Woller, SC, Bernstein, SJ, Chopra, V. The association between PICC Use and venous thromboembolism in upper and lower extremities. Am J Med 2015;128:986–993.Google Scholar
23. Marra, AR, Opilla, M, Edmond, MB, Kirby, DF. Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition. J Clin Gastroenterol 2007;41:19–28.Google Scholar
24. Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908–918.Google Scholar
25. D’Hoore, W, Sicotte, C, Tilquin, C. Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 1993;32:382–387.Google Scholar
26. Centers for Disease Control and Prevention (CDC). Centers for Disease Control and Prevention/National Healthcare Safety Network Device associated module: central line associated bloodstream infection (CLABSI) event. CDC website. http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published 2015. Accessed May 10, 2016.Google Scholar
27. Miller, J, Dalton, MK, Duggan, C, et al. Going with the flow or swimming against the tide: should children with central venous catheters swim? Nutr Clin Pract 2014;29:97–109.CrossRefGoogle ScholarPubMed
28. Cox, AM, Malani, PN, Wiseman, SW, Kauffman, CA. Home intravenous antimicrobial infusion therapy: a viable option in older adults. J Am Geriatr Soc 2007;55:645–650.Google Scholar
29. Barr, DA, Semple, L, Seaton, RA. Outpatient parenteral antimicrobial therapy (OPAT) in a teaching hospital-based practice: a retrospective cohort study describing experience and evolution over 10 years. Int J Antimicrob Agents 2012;39:407–413.CrossRefGoogle Scholar
30. Perez-Lopez, J, San Jose Laporte, A, Pardos-Gea, J, et al. Safety and efficacy of home intravenous antimicrobial infusion therapy in older patients: a comparative study with younger patients. Int J Clin Pract 2008;62:1188–1192.Google Scholar
31. Allison, GM, Muldoon, EG, Kent, DM, et al. Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy. Clin Infect Dis 2014;58:812–819.Google Scholar
32. Cramer, S, Fonager, K. Risk factors of 30-days re-hospitalization after Hospital at Home in a cohort of patients treated with parenteral therapy. Eur J Intern Med 2014;25:895–899.Google Scholar
33. Huck, D, Ginsberg, JP, Gordon, SM, Nowacki, AS, Rehm, SJ, Shrestha, NK. Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme. J Antimicrob Chemother 2014;69:228–233.Google Scholar
34. Centers for Medicare and Medicaid Services (CMS). Mapping Medicare disparities. CMS website. https://data.cms.gov/mapping-medicare-disparities. Published 2016. Accessed May 10, 2016.Google Scholar
35. Keller, S, Pronovost, P, Cosgrove, S. What Medicare is missing. Clin Infect Dis 2015;61:1890–1891.Google Scholar
36. National Home Infusion Association (NHIA). Medicare and home infusion: an NHIA white paper. NHIA website. http://www.nhia.org/resource/legislative/NHIAMHISOCAWhitePaper.cfm. Published 2015. Accessed May 10, 2016.Google Scholar
37. Isakson, J. Medicare home infusion site of care act of 2015. Senate Bill 275, Session 114. http://www.govtrack.us/. Published 2015. Accessed May 13, 2016.Google Scholar
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