Background and Aims Central venous catheter-associated bloodstream infection (CBSI) is a serious complication in home parenteral nutrition (HPN) patients. Prevention of CBSI in hospitals is well-established, but in the home environment presents additional challenges. We applied hazard analysis and critical control points principles to develop a systematic approach to preventing HPN-related CBSI. Here we describe the corrective actions and their clinical impact.
Methods Factors predisposing to infection, and corrective actions were identified through consensus by a multidisciplinary group of healthcare professionals between April and June 2012. The impact of these actions on CBSI was observed.
Results Key corrective actions were:
Staphylococcus aureus nasal screening and decolonisation where appropriate.
Multidisciplinary discharge planning meetings included consideration of patients’ microbiology histories and optimisation of treatment of comorbidities (e.g. atopic eczema).
Increased monitoring of line access and care practices at home, aiming to attain the same standards as in hospital.
Launch of updated illustrated guide to identification and management of line site problems.
Streamlining of microbiology result reporting to facilitate early treatment of local infections.
Taurolidine locks for one patient with a poor line infection history.
Between April 2011 and March 2012 there were 13 CBSI acquired outside hospital, and during planning and implementation of corrective actions (April–June 2012) there were 4 CBSI. By contrast there was only one CBSI during the in the nine months following full implementation.
Conclusion A multidisciplinary approach to the ongoing management of HPN patients can dramatically reduce their risk of CBSI.
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