Alcohol-impregnated disinfectant caps and central line associated bloodstream infections

PICOT -- Finding Evidence

The purpose of this posting is to present a PICOT question regarding the impact of alcohol-impregnated disinfectant caps affect the rate of central line associated bloodstream infections compared to non-alcohol impregnated caps during a period of one year..

PICOT:

P - In patients with peripherally inserted central venous catheters

how does alcohol-impregnated disinfectant caps

compared to non-alcohol impregnated caps

O - affect the rate of central line associated bloodstream infections (CLABSI)

within one year

Databases

The databases used to conduct the search include the following: Medline; Cumulative Index to Nursing and Allied Health (CINAHL); Three Cochrane databases were searched, including Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects; and PUBMED. The reason that these databases were chosen for the search for evidence on the topic of interest was that they are known to produce current and highly relevant full-text research articles.

Search Terms & Process

Digital searches were conducted of published literature in primary and secondary sources of electronic databases. The initial scoping searches were focused on the key search terms associated with the PICOT question. Key search terms included: Central venous catheters, alcohol-impregnated disinfectant caps, non-alcohol impregnated caps, central linebloodstream infections, CLABSI. The search strategy combined relevant controlled vocabulary and natural language so that specificity could be balanced with sensitivity.

Overall, searches were not date specific. Only publications written in English were searches. No effort was made to systematically search grey literature, such as abstracts, conference proceedings, theses, and unpublished trials. No hand-searches of periodicals not indexed on the databases were conducted. Searches took place over a period of two weeks in February 2015.

Selected Evidence

The following articles were selected as key starting points for the literature search as the content is representative of the issue in the field.

Menyhay, S.Z. & Maki, D.G. (2006, January). Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap. Infection Control Hospital Epidemiology, 27(1), 23-27. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16418982

This article was included because the findings show that conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms in heavily contaminated membranous septum of a needleless luer-activated connector. However, the antiseptic-barrier cap provided a high level of protection, even in the presence of very heavy contamination.

Omiwade, O. (2013). Efficacy of alcohol-impregnated port protectors on central line-associated blood stream infections in intensive care units. Unpublished dissertation. University of North Texas Health Science Center: UNTHSC Scholarly Repository

This article was included since it focused on assessing the effectiveness of alcohol-impregnated port protectors (A-IPP) in reducing the infection rate in patients with central venous catheters in intensive care units. Infection rate data was obtained from a local hospital, and a comparison was made between the infection rates before and after the use of A-IPP. Overall, the risk of infection was found to be extremely low.

Sweet, et al. (2012). Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. American Journal of Infectious Control, 40(10), 931-4.

This article was included since it provided a discussion on a comparison of alcohol-impregnated port protectors and needleless neutral pressure connectors with regard to central-line associated bloodstream infections and contamination of blood cultures.

The Joint Commission. (2012). Preventing central line -- associated bloodstream infections: A global challenge, a global perspective.

This comprehensive monograph was included because it serves as good overall platform for the topic. Included in the monograph are discussions about the types of central venous catheters and risk factors for and pathogenesis of CLABSIs . Evidence-based guidelines and patient safety initiatives, as well as position papers and published literature on CLABSI are also covered in the monograph. Detailed discussion of the prevention strategies, techniques and technologies CLABSI are included, along with a balanced discussion of barriers to best practices. Moreover, information about CLABSI surveillance, benchmarking, and public reporting is addressed. The monograph is so inclusive that a section on the economic aspects of CLABSIs and their prevention, and the current approaches to developing a business case for infection prevention resources, are also covered.

Wright, M, Tropp, J., Schora, D., Dillon-Grant, M., Peterson, K. Boehm. S., Robicsek, A. & Peterson, L. (2013). Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. American Journal of Infection Control 41, 33-8

This study investigated a catheter hub decontamination process that required a thorough scrub and, as such, compliance by staff varied. The effectiveness of a disinfection cap with 70% alcohol was evaluated in preventing contamination and/or infection. The study showed that the use of disinfecting caps reduced line contamination, organism density, and CLABSIs.

Conclusion

Commonly accessed electronic databases were searched using key search words related to the topic of bloodstream infections due to central line intrusion. The search for articles related to the topic provided information on alcohol-impregnated disinfectant caps, non-alcohol impregnated caps, and a comprehensive monograph on central line associated bloodstream infections (CLABSI).

Reference:

Menyhay, S.Z. & Maki, D.G. (2006, January). Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap. Infection Control Hospital Epidemiology, 27(1), 23-27. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16418982