Intravascular device administration sets: Replacement after Standard Versus Prolonged use (The RSVP Trial)

INTERVENTION: Patients in this study have intravascular devices (IVDs) used in medical, surgical, intensive care, oncology and haematology units, and include adult and paediatric patients. Patients will have their administration set replaced every 4 days. This will continue for the course of their intravenous (IV) therapy. CONDITION: Intravascular device related blood stream infection PRIMARY OUTCOME: IVD‐related Bloodstream Infection (IVD‐BSI): (1) Primary bacteraemia/fungaemia with >=1 positive blood culture from a peripheral vein with no other identifiable source for the BSI other than the IVD, plus, one of: a positive semiquantitative (>15cfu) device culture, with the same organism (species and antibiogram) isolated from the device and blood, or (2) Two blood cultures (one from an IVD hub and one from a peripheral vein), that both meet the CRBSI criteria for differential time to positivity (DTP) (growth of the same microbe from hub drawn blood at least 2 hours before growth from the peripheral blood) SECONDARY OUTCOME: (i) IVD Colonisation: Growth of >15 CFU from distal segment of IVD tip on removal, using the semiquantitative culture method (ii) Administration set (AS) colonisation: Growth of 10^3 CFU/ml from infusate taken from the AS. (iv) All cause mortality: Mortality at hospital discharge (v) Time the IVD was in situ. (vii) Costs. AS consumable prices, staff time and treatment costs for IVD‐BSI. All cause BSI: Any positive blood culture result Infusate Related bloodstream Infection (IRBSI): Concordant growth of the same organism from the infusate and blood cultures with no other identifiable source of infection Possible CRBSI: One or more positive blood cultures drawn through two or more lumens of an IVD, where one of the blood cultures has a colony count at least 3‐fold greater than the colony count for the blood culture obtained from the second lumen. vi) AS per patient. INCLUSION CRITERIA: 1. Informed written consent or waived consent (as per approving HREC) 2. Central venous or peripheral arterial IVD in situ. 3. IVD and AS have been insitu for 72‐95 hours 4. IVD scheduled/expected use > or =7 days