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

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Keller, Sara C. ; Williams, Deborah ; Gavgani, Mitra ; Hirsch, David ; Adamovich, John ; Hohl, Dawn ; Krosche, Amanda ; Cosgrove, Sara ; Perl, Trish M.
• Description:
  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.
  
  
• Subjects:
  Adult Aged Baltimore Catheterization, Central Venous / Adverse Effects* Central Venous Catheters Environmental Exposure Female Home Infusion Therapy Humans Logistic Models Male Middle Aged Multivariate Analysis Parenteral Nutrition, Total Patient Readmission Prospective Studies Risk Factors

  More +
• Source:
  Infect Control Hosp Epidemiol. 38(1):68-75.
• Pubmed ID:
  27697084
• Pubmed Central ID:
  PMC5502130
• Document Type:
  Journal Article
• Funding:
  KL2 TR000425/TR/NCATS NIH HHS/United States ; KL2 TR001077/TR/NCATS NIH HHS/United States ; U54 CK000447/CK/NCEZID CDC HHS/United States
• Volume:
  38
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f9e16bec1dc6527d84a2564e1acd01b6559b1a1dfc7a2d6310468ccdf76621c4
• Download URL:
  https://stacks.cdc.gov/view/cdc/46679/cdc_46679_DS1.pdf
• File Type:
  [PDF - 450.48 KB ]