P020 - Implementing KiteLock, a 4% EDTA Central Line Locking Solution, as a Quality Improvement Project in a Large Canadian Hospital During a Pandemic
Janell Wohlgemut, BScN, MScN - Nurse Practitioner, Hamilton Health Science Kwadjo Ntow, BSc, MSc - Research Assistant, Hamilton Health Sciences Ari Collerman, BScN, MScN - Chief of Interprofessional Practice, Hamilton Health Sciences Prathiba Harsha, MSc - Clinical Innovation Manager, Hamilton Health Sciences Basma Chamas, . - Clinical Innovation Coordinator, Hamilton Health Science Mark Brown, BSc, PharmD - Pharmacy Manager, Hamilton Health Science Tim Dietrich, BSc, MMath - Director, Hamilton Health Science Cheryl Main, .MD, FRCPC - Infectious Diseases, Medical Microbiology, Hamilton Health Science Leanne Tremain - Clinical Manager Vascular Access, Hamilton Health Science
Hamilton Health Science , Hamilton Health Sciences , Hamilton Health Sciences , Hamilton Health Sciences , Hamilton Health Science , Hamilton Health Science , Hamilton Health Science , Hamilton Health Science , Hamilton Health Science
Clinical Manager of Vascular Access Hamilton Health Sciences New Hamburg, Ontario, Canada
Purpose - What was the goal of the study?: To determine whether the introduction of KiteLock 4% could improve patient safety by decreasing central line-associated bloodstream infections (CLABSIs) rates and central catheter occlusions in a large hospital and cancer center during the COVID-19 pandemic.
Background - What was the problem? Why was it important?: Oncology patients often require central vascular access devices (CVAD) during their frequent therapies and supportive care. However, CVADs are associated with many complications, notable of which are CLABSIs and CVAD thrombotic occlusions. There has been a 63% increase in CLABSIs since the COVID-19 pandemic. CLABSIs may lead to sepsis and increase the risk of morbidity and mortality. Central line occlusions drastically delay patient care and treatments and produce a conducive environment for line infections. KiteLock 4% EDTA is a non-antibiotic antimicrobial CVAD locking solution that has proven to be effective at decreasing both CLABSIs and thrombotic occlusions. As an anticoagulant, it reduces the use of Cathflo for line occlusions. As a non-antibiotic antimicrobial and anti-biofilm agent, KiteLock 4% reduces CLABSIs without the risk of antimicrobial resistance. Hamilton Health Sciences, in partnership with CAN Health conducted a retrospective pre-post quality improvement project to explore the effectiveness and practicality of using KiteLock at Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada. KiteLock was implemented in adult oncology, hematology, surgical oncology, and critical care patient populations.
Results - What were the findings?: CLABSIs data were available for hematology and oncology units only. There were 36 total CLABSI cases 16 months prior to the introduction of KiteLock 4% (27 annualized cases). In the six months KiteLock was implemented, there were 6 cases of CLABSIs (12 annualized cases). Two-sample Poisson rate hypothesis tests showed a statistically significant decrease of 59% in CLABSIs per 1000 line days (p=0.046). There was no statistically significant difference in Cathflo use in participating inpatient units (p=0.657).
Conclusions - What do the final outcomes mean?: It appears that KiteLock 4% is a viable alternative locking solution that may help prevent CLABSIs. Although there were no differences in Cathflo use, the challenges of the COVID-19 pandemic and nursing shortages likely affected the results. More randomized control clinical trials should be conducted to help ascertain a causal link between KiteLock and CLABSIs rates.
