This paper presents a systematic literature search on the effectiveness of alcohol-impregnated disinfectant caps in reducing central line-associated bloodstream infections (CLABSI) compared to non-alcohol impregnated caps. The PICOT question frames the inquiry around patients with peripherally inserted central venous catheters over a one-year period. The search utilized major healthcare databases including MEDLINE, CINAHL, Cochrane databases, and PubMed to identify current, peer-reviewed evidence. Five key studies and resources were selected, revealing that alcohol-impregnated caps demonstrate significant promise in reducing contamination and infection rates when compared to conventional disinfection methods alone, with implications for hospital infection control protocols.
The purpose of this paper is to present a PICOT question regarding the impact of alcohol-impregnated disinfectant caps on the rate of central line-associated bloodstream infections compared to non-alcohol impregnated caps during a period of one year.
The PICOT framework structures the clinical inquiry as follows:
P (Population): Patients with peripherally inserted central venous catheters
I (Intervention): Alcohol-impregnated disinfectant caps
C (Comparison): Non-alcohol impregnated caps
O (Outcome): Rate of central line-associated bloodstream infections (CLABSI)
T (Timeframe): Within one year
Multiple electronic databases were selected to conduct a comprehensive literature search on this topic. The databases used include MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), three Cochrane databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects), and PubMed.
These databases were chosen because they are recognized for producing current and highly relevant full-text research articles in nursing, healthcare, and related fields. PubMed and MEDLINE are particularly valuable for identifying peer-reviewed clinical studies, while CINAHL provides comprehensive coverage of nursing and allied health literature. The Cochrane databases offer systematic reviews and synthesized evidence, making them essential resources for evidence-based healthcare questions.
Digital searches were conducted of published literature in primary and secondary sources from electronic databases. Initial scoping searches focused on key search terms associated with the PICOT question. Key search terms included: central venous catheters, alcohol-impregnated disinfectant caps, non-alcohol impregnated caps, central line bloodstream infections, and CLABSI. The search strategy combined relevant controlled vocabulary and natural language to balance specificity with sensitivity.
Searches were not date-specific, though only publications written in English were included. No systematic effort was made to search grey literature such as abstracts, conference proceedings, theses, and unpublished trials. Hand-searches of periodicals not indexed in the selected databases were not conducted. The literature search took place over a two-week period in February 2015.
The following articles and resources were selected as key starting points for the literature search because their content is representative of the issue in the field and directly addresses the PICOT question.
Menyhay and Maki (2006) investigated disinfection of needleless catheter connectors and access ports. Their findings demonstrated 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. This seminal study provides evidence supporting the use of alcohol-impregnated caps as a superior alternative to alcohol disinfection alone.
Omiwade (2013) assessed the effectiveness of alcohol-impregnated port protectors (A-IPP) in reducing infection rates in patients with central venous catheters in intensive care units. Infection rate data was obtained from a local hospital, with a comparison made between infection rates before and after implementation of A-IPP. The study found that the overall risk of infection was extremely low following use of alcohol-impregnated port protectors, suggesting significant clinical benefit in high-risk care environments.
Sweet and colleagues (2012) compared alcohol-impregnated port protectors and needleless neutral pressure connectors with regard to central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. This study provided direct evidence of the impact of these protective technologies on infection rates and culture contamination in a specialized clinical setting where patients may be particularly vulnerable to healthcare-associated infections.
The Joint Commission (2012) published a comprehensive monograph on preventing central line-associated bloodstream infections from a global perspective. This resource serves as an excellent overall platform for the topic, including discussions of types of central venous catheters and risk factors for and pathogenesis of CLABSIs. The monograph covers evidence-based guidelines, patient safety initiatives, position papers, and published literature on CLABSI. It provides detailed discussion of prevention strategies, techniques, and technologies, along with balanced discussion of barriers to best practices. Additionally, the monograph addresses CLABSI surveillance, benchmarking, and public reporting, as well as economic aspects of CLABSIs and approaches to developing a business case for infection prevention resources.
Wright and colleagues (2013) investigated continuous passive disinfection of catheter hubs as a contamination prevention strategy. Their study evaluated a catheter hub decontamination process and examined the effectiveness of a disinfection cap with 70% alcohol in preventing contamination and infection. The research showed that the use of disinfecting caps reduced line contamination, organism density, and CLABSIs. This finding supports the mechanism by which alcohol-impregnated caps protect against bloodstream infection by addressing a critical point of vulnerability in the central line system.
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). The selected evidence demonstrates the clinical effectiveness of alcohol-impregnated protective technologies in reducing infection rates across multiple care settings, from intensive care units to oncology services, supporting their implementation as part of comprehensive central line infection prevention protocols.
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