Typically when infection preventionists (IP) evaluate bloodstream infection rates, their initial thoughts turn to central line compliance. Rarely is there much attention given to the use of multichamber bags versus compounded bags for parenteral nutrition.
But a study that was presented at the Infectious Diseases Society of America's (IDSA) 47th annual meeting October 29–November 1 found that the way in which parenteral nutrition is delivered could affect bloodstream infections among high-risk patients.
Authors of the study focused their research specifically on the oncology unit because patients in that unit are already susceptible to infections, says Robin Turpin, PhD, senior director of health economics in IV nutrition at Baxter Healthcare Corporation in Deerfield, IL.
"In this particular analysis, we were interested in looking at the oncology population because they were high risk," Turpin says. "They already have a compromised immune system, so we had thought they might be at a higher risk [for bloodstream infections]."
By evaluating data among 19,540 patients, Turpin and her colleagues found that patients who were given compounded bags were more likely to have major or extreme illness severity, more days of parenteral nutrition, more days in the ICU, and a longer overall hospital length of stay. After adjusting baseline differences, the study concluded that the adjusted probability for bloodstream infections was 19% higher for compounded bags compared to multichamber bags.
"It has been fairly well documented in literature that parenteral nutrition is a risk factor for bloodstream infections, but we were curious as to, in general, if different types of preparation may have a higher risk versus another," Turpin says. "Because compounding parenteral nutrition is a very different process than a multichamber bag, we were curious."
Compounding is more popular
Compounding parenteral nutrition is a process in which a pharmacist takes the amino acids, dextrose, and perhaps lipids, depending on the physician's prescription, and literally mixes the nutrients in the pharmacy under aseptic conditions. Multichamber bags are dual-chamber bags with premixed solution that can be mixed by rolling the chambers together. Additional vitamins and micronutrients can be added if needed.
For whatever reason, the compounding process has become a standard of practice in the United States, says Turpin. The IDSA study found that more than 18,000 of the 19,540 patients were given compounded parenteral nutrition. Other countries, such as France, favor multichamber bags.
"I don't think there is necessarily clinical evidence for that," Turpin says. "In the U.S., there is just a lot of compounding."
Developing a standardized process
The reason multichamber bags may lead to fewer bloodstream infections is because they involve a much more uniform process. Compounded bags provide a much larger window for human error by breaking a sterile barrier.