Category: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

Poster Session: Pediatric Antimicrobial Stewardship (inpatient/outpatient pediatric focused)

1336 - Alcohol Impregnated Caps and Ambulatory CLABSI: Multicenter Cluster Randomized, Crossover Trial

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Presenting Author(s)

Aaron Milstone

Professor
Johns Hopkins University
Baltimore, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

CR

Carol E. Rosenberg

Clinical Quality Improvement Consultant
Children's Hospital Association
Washington, District of Columbia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GY

Gayane Yenokyan, PhD

Associate Scientist
Johns Hopkins Biostatistics Center
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DK

Danielle W. Koontz

Research Coordinator
JHU SOM
Baltimore, Maryland
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Marlene R Miller MD MSc

Pediatrician-in-Chief and Chair of Pediatrics
UH Rainbow Babies and Children's
Cleveland, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Central line-associated bloodstream infections (CLABSI) cause significant morbidity and mortality and occur more commonly in the ambulatory setting in pediatric oncology patients. Whether alcohol impregnated caps placed on central venous lines can prevent CLABSI in ambulatory pediatric oncology patients is unknown.

Methods: We performed a cluster-randomized, 2 period, crossover trial at 16 pediatric hematology/oncology clinics. Clinics were randomly assigned to usual ambulatory central line care per each institution (control) compared to use of 70% isopropyl alcohol-containing caps at home (intervention). Caps were only used in the ambulatory setting. The primary outcome was ambulatory CLABSI. Secondary outcomes included ambulatory mucosal barrier injury (MBI) CLABSI, secondary blood stream infections, single positive blood cultures, and positive blood cultures.

Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no statistically significant reduction in incidence of ambulatory CLABSI in patients using 70% isopropyl
alcohol-impregnated caps at home (1.23 per 1000 days, 95% CI 0.94, 1.60) compared with standard practices (1.38 per 1000 days, 95% CI 1.08, 1.77; adjusted incidence rate ratio [aIRR] 0.83, 95% CI 0.61,
1.12). There was no reduction in incidence of ambulatory MBI-CLABSI (aIRR 0.57, 95% CI 0.23, 1.40), single positive blood culture (aIRR 1.35, 95% CI 0.74, 2.48), or positive blood cultures (aIRR 0.80, 95% CI 0.60, 1.07). In the per protocol analysis, there was a reduction in incidence of positive blood cultures in ambulatory patients using 70% isopropyl alcohol-impregnated caps at home (1.51 per 1000 days, 95% CI
1.14, 2.00) compared with standard practices (1.88 per 1000 days, 1.47, 2.39; aIRR 0.72, 95% CI 0.51, 1.00).

Conclusion: Isopropyl alcohol- impregnated caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology/oncology patients, however, there was a reduction in positive blood cultures in the ambulatory setting in the per protocol analysis. Further research is needed to understand the clinical impact of alcohol-impregnated caps in the ambulatory setting.