Evaluating a Novel Hemodialysis Central Venous Catheter Cap in Reducing Bloodstream Infections: A Quality Improvement Initiative

Figures & data

Figure 1 Antimicrobial barrier cap (ClearGuard™ HD) used in the chlorhexidine group.

Table 1 Comparison of CLABSI Rates by Study Group

Study Group	Total Number of Patients (N)	CVC Days	CLABSI	CLABSI/1000 CVC Days	p-value
First Study Period
Chlorhexidine	967	29,010	1	0.03	<0.0001
Standard Therapy	1044	31,320	22	0.70
First + Second Study Periods
Chlorhexidine	4614	138,420	13	0.09	<0.0001
Standard Therapy	1320	39,600	25	0.63

Abbreviations: CLABSI, central line-associated bloodstream infection; CVC, central venous catheter.

Table 2 Comparison of CLABSIs by Study Month and Study Group

2018–2019	Total Number of Patients (N)		CVC Days			CLABSI		CLABSI/1000 CVC Days
	Chlorhexidine	Standard	Chlorhexidine		Standard	Chlorhexidine	Standard	Chlorhexidine	Standard	p-value
First Study Period
May	189	199	5670		5970	0	0	0	0.00
June	191	215	5730		6450	1	9	0.17	1.40
July	190	218	5700		6540	0	2	0	0.31
August	209	201	6270		6030	0	4	0	0.66
September	188	211	5640		6330	0	7	0	1.11
Subtotal^a	967	1044	29,010		31,320	1	22	0.03	0.70	<0.0001
Second Study Period
October	268	158	8040		4740	1	1	0.12	0.21
November	337	76	10,110		2280	2	1	0.20	0.44
December	386	27	11,580		810	1	1	0.09	1.23
January	417	15	12,510		450	2	0	0.16	0.00
February	437	0	13,110		0	3	0	0.23	-
March	438	0	13,140		0	2	0	0.15	-
April	447	0	13,410		0	1	0	0.07	-
May 2019	465	0	13,950		0	0	0	0.00	-
June 2019	452	0	13,560		0	0	0	0.00	-
Total^b	4614	1320	138,420		39,600	13	25	0.09	0.63	<0.0001

Notes: ^aFirst study period subtotal. ^bFirst and second study period total.

Abbreviations: CLABSI, central line-associated bloodstream infection; CVC, central venous catheter.

Figure 2 CLABSI/1000 CVC days by study group.

Notes: *Standard group had 0 CLABSIs out of 5970 CVC days and chlorhexidine group had 0 CLABSIs out of 5670 CVC days during May 2018.Abbreviations: CLABSI, central line-associated bloodstream infection; CVC, central venous catheter.

Table 3 Causative Organisms Isolated from Central-Line Associated Bloodstream Infections Among Patients Dialyzed via Central Venous Catheters

Isolates (N=42)	n (%)
Gram-positive organism	25 (59.5)
Coagulase-negative Staphylococcus Species (CoNS)	11 (26.2)
Methicillin-resistant Staphylococcus aureus (MRSA)	5 (11.9)
Staphylococcus epidermidis	3 (7.1)
Staphylococcus aureus	2 (4.8)
Staphylococcus capitis	1 (2.4)
Enterococcus faecalis	1 (2.4)
Vancomycin-resistant Enterococcus faecalis	1 (2.4)
Streptococcus salivarius	1 (2.4)
Gram-negative organism	17 (40.5)
Acinetobacter baumannii	4 (9.5)
Entereobacter clocae	3 (7.1)
Pantoea agglomerans	2 (4.8)
Escherichia coli	2 (4.8)
Klebsiella pneumoniae	2 (4.8)
Serratia marcescens	1 (2.4)
Stenotrophomonas maltophilia	1 (2.4)
Raoultella planticola	1 (2.4)
Citrobacter Freundii	1 (2.4)

Notes: 38 central line-associated bloodstream infections (CLABSIs) with 42 isolates were identified among patients dialyzed via central venous catheters; 34 CLABSIs were monomicrobial; 4 CLABSIs were polymicrobial.