(C2) Using, a 4% EDTA Central Line Locking Solution, as a Quality Improvement Project in a Large Canadian Hospital During a Pandemic

Oncology patients often require central vascular access devices (CVAD) during supportive care. CVADs are associated with many complications, notable of which are CLABSIs, biofilm and thrombotic occlusions. There has been a 63% increase in CLABSIs since the COVID-19 pandemic. HHS piloted a 4%™EDTA, a non-antibiotic antimicrobial CVAD locking solution that has proven to be effective at preventing CLABSIs, occlusions and biofilm.

Catheter line associated blood stream infections (CLABSI) and intraluminal occlusions are common complications in vascular access devices. We now understand that the interrelationship between bacteria, biofilm, and fibrin are responsible for the high incidence of treatment failure and catheter loss. It is through the understanding of these complex interactions in Central Venous Access Devices (CVADs) that we can begin to develop strategies to improve outcomes. The approach to solving this complex clinical problem may be multifactorial and finding an effective catheter lock solution is an important piece of the puzzle.

Oncology patients often require CVADs during their frequent therapies and supportive care. CVADs are associated with many complications, notable of which are CLABSIs and CVAD thrombotic occlusions. There has also been a reported 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. 4% EDTA is a trusted anticoagulant and non-antibiotic antimicrobial CVAD locking solution that has proven to be effective at decreasing both CLABSIs and thrombotic occlusions. 4% EDTAs ability to inhibit clot formation as well as remove intraluminal microorganisms and biofilm has proven to significantly reduce CLABSI rates, reduce the risk of antimicrobial resistance as well as decrease the use of Alteplase. Hamilton Health Sciences conducted a retrospective pre-post quality improvement project to explore the effectiveness and practicality of using 4% EDTA at Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada. An 4% EDTA was implemented in adult oncology, hematology, surgical oncology, and critical care patient populations.

Results: 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 Alteplase use in participating inpatient units (p=0.657).