Preventing CLABSI Infection with 70% Alcohol Impregnated Caps
Appraised By:
Sabrina Brunelle SN, Alexandra Davis SN, Anna Hopkins SN, Taylor Lewis SN
NDSU School of Nursing at Bismarck
Clinical Question:
For patients with central lines, does the use of 70% alcohol impregnated caps reduce the risk for CLABSI in comparison with “scrubbing the hub” for 30 seconds.
Articles:
Cameron-Watson, C. (2016). Port protectors in clinical practice: an audit. British Journal
of Nursing, 25(8), S25-S31
Merrill, K. C., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact of
universal disinfectant cap implementation of central line-associated
bloodstream infections. American Journal of Infection Control, 42(12),
1274-1277.
Ramirez, C., Lee, A.M., & Welch, K. (2012). Central venous catheter protective
connector caps reduce intraluminal catheter-related infection. Journal of the
Association for Vascular Access. 17(4), 210-213. doi:
10.1016/j.java.2012.10.002
Wright, M., Tropp, J., Schora, D. M., Dillon-Grant, M., Peterson, K., Boehm, S.,
Peterson, L. R. (2013). Continuous passive disinfection of catheter hubs prevents
contamination and bloodstream infection.American Journal of Infection
Control,41(1), 33-38. doi:10.1016/j.ajic.2012.05.030
Synthesis of Evidence:
Four articles were reviewed for this report including one non-randomized perspective trial, one non-randomized control trial and two quasi-experimental controlled studies.
Cameron-Watson (2016) conducted a non-randomized controlled trial that aimed to determine if 70% alcohol impregnated caps (Curos Disinfecting Caps) helped reduce CLABSI infections compared to “scrubbing the hub” for 30 seconds. This study was conducted in the United Kingdom in 2014. Patients on the oncology, acute care of the elderly, critical care and surgical wards in the particular hospital were considered for the study and the patients had to have either a central venous catheter, peripheral IV catheter or arterial VAD. Before the implementation of the caps, the hospital was using “scrub the hub” to disinfect the catheters before access. In total, 1094 patients were involved in the study. The hospital implemented the use of Curos Disinfecting Caps for 6 months and the CLABSI infection rates from before the implementation of the Curos Disinfecting Caps were compared to the rates during the 6-month trial period. During the 6-month period, CLABSI rates dropped by 69%
This is a quasi-experimental intervention study by Merrill, et al. (2014) that was completed in a level 1 trauma center with greater than 430 beds. This study compares the use of alcohol impregnated disinfectant caps for central lines as an alternative to the use of “scrub-the-hub” and explores it’s effect on the rates of central line-associated blood stream infections, also known as CLABSI. In this study, the disinfectant cap was placed universally on all IV needleless connectors (central, peripheral, and IV tubing) when the connectors were not in use. Compliance to the disinfectant cap was monitored weekly and reported to each unit to encourage use of the disinfectant cap. The results indicate a significant decrease in CLABSI rates with the implementation of the alcohol impregnated disinfectant caps by 40%. The use of the disinfectant cap was also associated with an estimated savings of almost $300,000 per year in the hospital studied.
Ramirez, Lee, and Welch (2012) conducted a nonrandomized prospective trial. This study was conducted to determine the effects of protective caps saturated with alcohol on the rate of CLABSI infections in ICU patients with central lines. Two ICU units of the 214 bed Banner Estrella Medical Center cared for patients with central venous catheters that were protected by 70% alcohol impregnated caps. The study was completed from March 11, 2011 through February 29, 2012. Interventions: multidisciplinary meetings to educate staff on the protective caps, especially focusing on registered nurses and respiratory therapists to maintain central line sterility. Availability of the caps was important, as they were kept in the medication rooms to maintain proper use of the caps. A survey tool was implemented to determine and document the compliance with the use of the protective caps. Results: Prior to the nonrandomized prospective study, there was four CLABSI infections in the ICU using the “scrub the hub” method. After the trial was completed in February, there was a total of one CLABSI infection in one-years’ time. The one CLABSI infection that did occur was due to an emergent central line that needed to be placed in a patient, and was left for an extended period. Overall, this study has found that using protective caps infused with 70% alcohol decreases the rate of CLABSI infections for patients in the ICU who have central lines.
The 3-phased, quasi-experimental study of adult patients with central lines conducted by Wright, et al. (2013) studied the use of 70% alcohol infused caps in 3 Chicago- affiliated NorthShore University HealthSystem hospitals. The study was performed in three phases which included the “scrub the hub method, the use of the 70% alcohol impregnated caps, and a return to the baseline practice of “scrub the hub”. The results of this study concluded that the disinfecting caps reduce line contamination, organism density and CLABSIs.
Conclusion:
After reviewing the four articles, the research concluded that using 70% alcohol impregnated caps effectively decreased CLABSI rates in the in-patient hospital setting in patients with central lines, peripheral IV catheters and arterial VAD lines. The studies were all compared to “scrubbing the hub” with an alcohol swab for 30 seconds and letting dry for 15 seconds. Citing the rates from the articles, the infection rates dropped by an average of approximately 60%.
Implications for Nursing Practice:
The articles show that 70% alcohol impregnated caps decreased CLABSI rates. Implementing passive disinfecting caps could drastically reduce length of hospital stays and increase hospital reimbursements.