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Fiorina E, Giustivi D, Gotti F, Akyüz E, Privitera D. The use of Hub Devices to reduce catheter-related infections in dialysis patients: A narrative review. J Vasc Access 2024:11297298241273559. [PMID: 39238163 DOI: 10.1177/11297298241273559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Catheter-related bloodstream infections are among the most critical issues associated with central venous catheters used for dialysis treatment. To reduce the incidence of this life-threatening complication, various strategies have been developed. Among these, Hub Devices have been introduced in clinical practice to prevent microbial growth at the hub of the catheter. METHODS A review was conducted to assess the effectiveness of Hub Devices in reducing bloodstream infections in central venous catheters for dialysis, compared to solid caps. The review analyzed existing literature from three bibliographic databases (PubMed, Embase, and CINAHL) to provide evidence-based recommendations for clinical practice. RESULTS After a thorough review of the available data, it was found that out of the 873 records screened, only six trials met the inclusion criteria. Albeit the number of patients observed in these trials was more than 25,000, due to the differences in the mechanism of action of different Hub Devices and the lack of a standardized criterion to identify and measure the outcomes, it is difficult to draw a firm conclusion. It is worth noting, however, that in five out of six trials examined, the Hub Devices exhibited a protective effect when compared to solid caps. CONCLUSIONS The use of Hub Devices appears to be associated with a reduction in catheter-related bloodstream infections in the central venous catheter dialysis population. However, the Hub Devices show interesting results that should be investigated with further well-designed prospective studies.
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Affiliation(s)
- Elisabetta Fiorina
- Department of Nephrology, University Maggiore della Carità Hospital, Novara, Italy
| | - Davide Giustivi
- Post-Anesthesia Care Unit, Vascular Access Team, ASST Lodi, Italy
| | - Federica Gotti
- Department of Emergency and Intensive Care, University Hospital Maggiore della Carità, Novara, Italy
| | - Elif Akyüz
- Department of Nursing, Kırıkkale University Faculty of Health Sciences, Turkey
| | - Daniele Privitera
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
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Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr 2023; 42:411-430. [PMID: 36796121 DOI: 10.1016/j.clnu.2022.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion catheter and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Loris Pironi
- University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS AOUBO, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Kurt Boeykens
- Vitaz Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, University of Paris VII, Clichy, France
| | - Stanislaw Klek
- Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland
| | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), UK
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Antiseptic barrier caps to prevent central line-associated bloodstream infections: a systematic review and meta-analysis. Am J Infect Control 2022:S0196-6553(22)00672-1. [PMID: 36116679 DOI: 10.1016/j.ajic.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Reliable and safe venous access is crucial for patients using central venous catheters (CVC). However, such CVCs carry a risk for central line-associated bloodstream infections (CLABSIs). Antiseptic barrier caps (ABCs) are a novel tool in the armamentarium for CVC disinfection. Our aim was to review the efficacy and safety of ABCs. METHOD A literature search was conducted using PubMed, EMBASE, Cochrane library, and CINAHL. Primary aim was to compare CLABSI rates in patients using ABCs versus standard care. Secondary aims included efficacy of ABCs in relevant subgroups (age, ABC brand, clinical setting), safety, compliance, and costs. Fifteen studies were included in the meta-analysis. RESULTS In total, 391 CLABSIs in 273,993 catheter days occurred in the intervention group versus 620 CLABSIs in 284,912 days in the standard care group, resulting in a risk ratio of 0.65 (95%CI 0.55-0.76; P<0.00001). Subgroup analyses showed similar effects, except for non-intensive care unit. In general, ABCs were safe, highly appreciated by patients and caregivers, and cost-effective, while compliance was easy to monitor. In most studies, a substantial risk of bias was observed. CONCLUSION In conclusion, while available evidence suggests that ABCs are effective, safe, easy in use, and cost-effective. However, due to the poor methodological quality of most available studies, more robust data should justify their use at this point.
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Dalcin CB, Souza SD, Anders JC, Pina JC, Carmo ACFD, Manzo BF, Rocha PK. Desinfecção de hubs e conectores de cateteres intravenosos. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: identificar métodos de desinfecção de hubs e conectores sem agulha dos cateteres intravenosos em pacientes hospitalizados e verificar a efetividade das intervenções para a prevenção de infecções de corrente sanguínea associada a cateter intravenoso. Método: revisão de escopo seguindo as recomendações de Joanna Briggs Institute. Busca realizada em bases de dados eletrônicas Pubmed, Embase, Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados Enfermagem e Bibliografía Nacional en Ciencias de la Salud Argentina, e estudos indicados por experts. A busca foi atemporal até setembro de 2020. Protocolo registrado na Open Science Framework. Resultados: foram incluídos 27 estudos, sendo que cinco foram Guidelines e 22 foram artigos publicados em periódicos. Existe grande variedade de métodos de desinfecção de hubs e de conectores. Para a desinfecção ativa, foram indicados Gluconato de Clorexedina, Isopropanol e Iodopovedina; para a desinfecção passiva, Gluconato de Clorexedina e Isopropanol. A quantidade do agente desinfetante variou de 0,25 mL a 0,6 mL. O tempo de fricção na desinfecção ativa variou de cinco segundos a 30 segundos, e o tempo de contato na desinfecção passiva variou de três minutos a sete dias. O tempo de secagem de agentes desinfetantes foi superior a cinco segundos. Conclusão: verifica-se variedade de métodos de desinfecção; no entanto, não há consenso sobre a melhor indicação. Necessita-se de estudos que evidenciem a quantidade de desinfetante, a pressão e o tempo de fricção e o tempo de secagem. Pesquisas com práticas de desinfecção utilizadas no Brasil e ensaios clínicos randomizados são necessários.
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Slye K, McKiernan M, Griffin A, Cremona A. A comparison of a home parenteral nutrition service with the current European (ESPEN) guidelines on chronic intestinal failure in adults. Clin Nutr ESPEN 2022; 50:289-306. [DOI: 10.1016/j.clnesp.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
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Simon A, Fahrendorf W, Hitschmann G. Preclinical evaluation of passive disinfection caps with a long-term catheter for the prevention of catheter-related bloodstream infection in pediatric cancer patients. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc20. [PMID: 34113538 PMCID: PMC8167456 DOI: 10.3205/dgkh000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The use of passive disinfection devices (disinfection caps) may be a beneficial part of a maintenance care bundle, aiming at the prevention of catheter-related bloodstream infections in pediatric cancer patients. This preclinical in vitro investigation tested the visual and mechanical integrity of a Broviac™ catheter hub after simulation testing with 122 3M™ CurosTM Stopper Disinfection Caps for Open Female Luers repeatedly attached and removed over 6 months. We found that these catheter hubs were compatible, fully operational, and airtight with use of 3M Curos stopper caps after 6 months of use with 122 caps per catheter hub.
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Affiliation(s)
- Arne Simon
- Pediatric Oncology and Hematology, Children's Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfgang Fahrendorf
- 3M Medical Solutions Division, Health Care Business Group, 3M Central Europe Region, 3M Deutschland GmbH, Neuss, Germany
| | - Guido Hitschmann
- Medical Solutions Division Laboratory, Europe, Middle East and Africa, 3M Deutschland GmbH, Neuss, Germany
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Greene ES. Challenges in reducing the risk of infection when accessing vascular catheters. J Hosp Infect 2021; 113:130-144. [PMID: 33713758 DOI: 10.1016/j.jhin.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Injection safety is essential to reduce the risk of healthcare-associated infections (HAIs) when accessing vascular catheters. This general review evaluates the contamination of vascular catheter access ports and associated HAIs in acute care settings, focusing on open lumen stopcocks (OLSs) and disinfectable needleless closed connectors (DNCCs). PubMed was searched from January 2000 to February 2021. OLS intraluminal surfaces are frequently contaminated during patient care, increasing the risk of HAIs, and neither an isopropyl alcohol (IPA) pad nor a port-scrub device can reduce contamination effectively. In contrast, DNCCs can be disinfected, with most studies indicating less intraluminal contamination than OLSs and some studies showing decreased HAIs. While the optimal DNCC design to reduce HAIs needs to be determined, DNCCs alone or stopcocks with a DNCC bonded to the injection port should replace routine use of OLSs, with OLSs restricted to use in sterile fields. Compliance with disinfection is essential immediately before use of a DNCC as use of a non-disinfected DNCC can have equivalent or greater risk of HAIs compared with use of an OLS. The recommendations for access port disinfection in selected national and international guidelines vary. When comparing in-vitro studies, clinical studies and published guidelines, consensus is lacking; therefore, additional studies are needed, including large randomized controlled trials. IPA caps disinfect DNCCs passively, eliminate scrubbing and provide a contamination barrier; however, their use in neonates has been questioned. Further study is needed to determine whether IPA caps are more efficacious than scrubbing with disinfectant to decrease HAIs related to use of central venous, peripheral venous and arterial catheters.
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Affiliation(s)
- E S Greene
- Department of Anesthesiology, Albany Medical College, Albany, NY, USA.
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Helder OK, van Rosmalen J, van Dalen A, Schafthuizen L, Vos MC, Flint RB, Wildschut E, Kornelisse RF, Ista E. Effect of the use of an antiseptic barrier cap on the rates of central line-associated bloodstream infections in neonatal and pediatric intensive care. Am J Infect Control 2020; 48:1171-1178. [PMID: 31948717 DOI: 10.1016/j.ajic.2019.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of antiseptic barrier caps reduced the occurrence of central line-associated bloodstream infections (CLABSI) in adult intensive care settings. We assessed the effect of the use of antiseptic barrier caps on the incidence of CLABSI in infants and children and evaluated the implementation process. METHODS We performed a mixed-method, prospective, observational before-after study. The CLABSI rate was documented during the "scrub the hub method" and the antiseptic barrier cap phase. Main outcomes were the number of CLABSIs per 1,000 catheter days (assessed with a Poisson regression analysis) and nurses' adherence to antiseptic barrier cap protocol. RESULTS In total, 2,248 patients were included. The rate of CLABSIs per 1,000 catheter days declined from 3.15 to 2.35, resulting in an overall incidence reduction of 22% (95% confidence interval, -34%, 55%; P = .368). Nurses' adherence to the antiseptic barrier cap protocol was 95.2% and 89.0% for the neonatal intensive care unit and pediatric intensive care unit, respectively. DISCUSSION The CLABSI reducing effect of the antiseptic barrier caps seems to be more prominent in the neonatal intensive care unit population compared with the pediatric intensive care unit population. CONCLUSIONS The antiseptic barrier cap did not significantly reduce the CLABSI rates in this study.
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Affiliation(s)
- Onno K Helder
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Erasmus MC Create4Care, Erasmus MC, Rotterdam, the Netherlands.
| | | | - Anneke van Dalen
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Laura Schafthuizen
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, Rotterdam, the Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Robert B Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | - Enno Wildschut
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - René F Kornelisse
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Internal Medicine, Section of Nursing Science, Erasmus MC, Rotterdam, the Netherlands
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Taşdelen Öğülmen D, Ateş S. Use of alcohol containing caps for preventing bloodstream infections: A randomized controlled trial. J Vasc Access 2020; 22:920-925. [PMID: 32854563 DOI: 10.1177/1129729820952961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A majority of bloodstream infections seen in intensive care units stem from intravascular catheters used on patients. Catheter hubs are the entrance for pathogenic microorganisms into the inner surfaces of the catheters. The pathogenic microorganisms colonization in the mentioned areas can cause central line-associated bloodstream infection (CLABSI). METHODS This study was conducted as a randomized controlled trial to investigate the effect of alcohol-containing caps on the prevention of CLABSI. Total of 95 patients participated in the study. Isopropyl alcohol-containing caps were used for protecting the needle-free connectors closing the hubs of the central venous catheters in the intervention group. However, the control group patient received standard catheter caps. RESULT There was a statistically significant difference between groups in terms of infection distribution (X2 = 13.058; p < 0.001). The risk of infection in the control group was 13.7 times higher than the risk of infection in the intervention group. DISCUSSION Our results suggest that alcohol-containing caps are effective or in preventing CLABSI. CONCLUSION These findings suggest that alcohol-containing caps on ports are effective in preventing CLABSI.
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Affiliation(s)
- Deniz Taşdelen Öğülmen
- Infection Control Nurse, Kartal Koşuyolu High Speciality Educational And Research Hospital, İstanbul, Turkey
| | - Sebahat Ateş
- School of Nursing, Maltepe Üniversity, İstanbul, Turkey
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Casimero C, Ruddock T, Hegarty C, Barber R, Devine A, Davis J. Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters. MEDICINES (BASEL, SWITZERLAND) 2020; 7:E49. [PMID: 32858838 PMCID: PMC7554993 DOI: 10.3390/medicines7090049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
Catheter related blood stream infection is an ever present hazard for those patients requiring venous access and particularly for those requiring long term medication. The implementation of more rigorous care bundles and greater adherence to aseptic techniques have yielded substantial reductions in infection rates but the latter is still far from acceptable and continues to place a heavy burden on patients and healthcare providers. While advances in engineering design and the arrival of functional materials hold considerable promise for the development of a new generation of catheters, many challenges remain. The aim of this review is to identify the issues that presently impact catheter performance and provide a critical evaluation of the design considerations that are emerging in the pursuit of these new catheter systems.
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Affiliation(s)
| | | | | | | | | | - James Davis
- School of Engineering, Ulster University, Jordanstown BT37 0QB, Northern Ireland, UK; (C.C.); (T.R.); (C.H.); (R.B.); (A.D.)
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Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, Lichota M, Mühlebach S, Van Gossum A, Wanten G, Wheatley C, Bischoff SC. ESPEN guideline on home parenteral nutrition. Clin Nutr 2020; 39:1645-1666. [PMID: 32359933 DOI: 10.1016/j.clnu.2020.03.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, St. Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Kurt Boeykens
- AZ Nikolaas Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | | | - Francisca Joly
- Beaujon Hospital, APHP, Clichy, University of Paris VII, France
| | | | - Simon Lal
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Stefan Mühlebach
- Division of Clinical Pharmacy and Epidemiology and Hospital Pharmacy, University of Basel, Basel, Switzerland
| | | | - Geert Wanten
- Intestinal Failure Unit, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carolyn Wheatley
- Support and Advocacy Group for People on Home Artificial Nutrition (PINNT), United Kingdom
| | - Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, Govil D, Mishra RC, Samavedam S, Pandit RA, Savio RD, Clerk AM, Srinivasan S, Juneja D, Ray S, Sahoo TK, Jakkinaboina S, Jampala N, Jain R. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020; 24:S6-S30. [PMID: 32205954 PMCID: PMC7085816 DOI: 10.5005/jp-journals-10071-g23183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. Methods This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper. Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. Results This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. Conclusion In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. Abbreviations list ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization How to cite this article Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6–S30.
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Affiliation(s)
- Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India, , e-mail:
| | - Ganshyam Jagathkar
- Department of Critical Care Medicine, Medicover Hospital, Hyderabad, Telangana, India, e-mail:
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan & MJM Hospital, Pune, Maharashtra, India, e-mail:
| | - Dhruva Chaudhary
- Department of Pulmonary and Critical Care, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, , e-mail:
| | - Kapil Gangadhar Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India, , e-mail:
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, Haryana, India, Extn. 3335, e-mail:
| | - Deepak Govil
- Department of Critical Care, Medanta Hospital, The Medicity, Gurugram, Haryana, India, , e-mail:
| | - Rajesh C Mishra
- Department of Critical Care, Saneejivini Hospital, Vastrapur, Ahmedabad, Gujarat, India, , e-mail:
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Rahul Anil Pandit
- Department of Intensive Care Unit, Fortis Hospital, Mumbai, Maharashtra, India, , e-mail:
| | - Raymond Dominic Savio
- Department of Critical Care Medicine, Apollo Hospital, Chennai, Tamil Nadu, India, e-mail:
| | - Anuj M Clerk
- Department of Intensive Care, Services Sunshine Global Hospital, Surat, Gujarat, India, e-mail:
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, , e-mail:
| | - Deven Juneja
- Department of Critical Care Medicine, Max Superspecialty Hospital, New Delhi, India, , e-mail:
| | - Sumit Ray
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India, e-mail:
| | - Tapas Kumar Sahoo
- Department of Critical Care, Medanta Hospital, Ranchi, Jharkhand, India, , e-mail:
| | - Srinivas Jakkinaboina
- Department of Critical Care Medicine, Citizens Specialty Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Nandhakishore Jampala
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India, , e-mail:
| | - Ravi Jain
- Department of Critical Care Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India, , e-mail:
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13
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Hankins R, Majorant OD, Rupp ME, Cavalieri RJ, Fey PD, Lyden E, Cawcutt KA. Microbial colonization of intravascular catheter connectors in hospitalized patients. Am J Infect Control 2019; 47:1489-1492. [PMID: 31345614 DOI: 10.1016/j.ajic.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/25/2019] [Accepted: 05/26/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections may be due to catheter connector colonization and intraluminal migration of pathogens. We assessed the colonization of the split septum catheter connector system, and subsequently the luer lock catheter connector system. METHODS This was a prospective, 2 phase, quality improvement study at a tertiary referral center. Each phase of the study was performed over 3 consecutive days in hospitalized patients receiving an active infusion; first with a split septum lever lock connector and second with a luer lock connector and alcohol port protector. The connectors were inoculated onto blood agar plates and incubated. Plates were assessed for microbial growth after 48-72 hours. RESULTS In phase I, 98 (41.9%) of 234 split septum connectors yielded microbial growth. In phase II, 56 (23.1%) of 243 luer lock connectors yielded microbial growth. In phase II only, there was a significant increased rate of contamination in peripheral catheters compared with all other catheters, and the rate of contamination on the acute care wards was significantly higher when compared with the intensive care units. CONCLUSIONS Bacterial colonization of the lever lock system was unacceptably high among all catheter types and hospital locations. Transition to luer lock catheter connectors and alcohol port protectors decreased the colonization; however, colonization still remained substantial. Causation of colonization cannot be determined with these results.
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Affiliation(s)
- Richard Hankins
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - O Denisa Majorant
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Mark E Rupp
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - R Jennifer Cavalieri
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Paul D Fey
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Elizabeth Lyden
- Epidemiology, University of Nebraska Medical Center, Omaha, NE
| | - Kelly A Cawcutt
- Department of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE.
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Slater K, Cooke M, Scanlan E, Rickard CM. Hand hygiene and needleless connector decontamination for peripheral intravenous catheter care-time and motion observational study. Am J Infect Control 2019; 47:1017-1019. [PMID: 30850248 DOI: 10.1016/j.ajic.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/27/2022]
Abstract
Good hand hygiene and "scrub the hub" practices are important to prevent bloodstream infections. This observational study (n = 108) found high compliance with "scrubbing the hub," although scrub time was shorter than the recommended duration (average 6.1 seconds). Compliance with hand hygiene before medication preparation (33%) and before medication administration (43%) showed room for improvement compared with postadministration (65%), the emergency setting and glove use were associated with poorer compliance (P < .01).
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Affiliation(s)
- Karen Slater
- Princess Alexandra Hospital, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
| | - Marie Cooke
- Alliance for Vascular Access Teaching & Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Emma Scanlan
- Princess Alexandra Hospital, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching & Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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15
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Wax DB, Shah A, Shah R, Lin HM, Katz D. Efficacy and Usability of a Novel Barrier Device for Preventing Injection Port Contamination: A Pilot Simulation Study. Anesth Analg 2019; 130:e45-e48. [PMID: 31136328 DOI: 10.1213/ane.0000000000004235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Contamination of intravenous (IV) ports and stopcocks has been associated with postoperative infections. We tested the usability and efficacy of a novel passive shielding device to prevent such contamination even in the absence of hand hygiene or port disinfection. In a desktop setting with deliberately contaminated hands, qualitative port contamination was detected after 5/60 (8.3%; 95% confidence interval [CI], 2.8-18.4) control port injections versus 0/60 (0%; 95% CI, 0-6.0) shielded injections (P = .025). In clinical simulations with a quantitative bioburden assay (measured in relative light units [RLUs]), median (interquartile range [IQR]) postsimulation bioburden was 46 (32-53) vs 27 (21-42) RLU for the control versus intervention groups (P = .036), yielding a median shift of -13 RLU (95% CI, -2 to -26) in favor of the shielding. Usability of the device was acceptable to practitioners.
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Affiliation(s)
- David B Wax
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Ochi F, Tauchi H, Nagai K, Moritani K, Ishii E. Pseudomonas oryzihabitans bacteremia in a child with peripheral T-cell lymphoma after allogeneic bone marrow transplantation. Pediatr Int 2018; 60:486-488. [PMID: 29878628 DOI: 10.1111/ped.13540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/09/2018] [Accepted: 02/16/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Fumihiro Ochi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.,Infection Control Team, Ehime University Hospital, Toon, Ehime, Japan
| | - Hisamichi Tauchi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.,Infection Control Team, Ehime University Hospital, Toon, Ehime, Japan
| | - Kozo Nagai
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kyoko Moritani
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Casey AL, Karpanen TJ, Nightingale P, Elliott TSJ. An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors. Antimicrob Resist Infect Control 2018; 7:50. [PMID: 29632665 PMCID: PMC5887218 DOI: 10.1186/s13756-018-0342-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/26/2018] [Indexed: 03/21/2023] Open
Abstract
Background The optimal decontamination method for needle-free connectors is still unresolved. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors. Methods The injection ports of needle-free connectors were inoculated with Staphylococcus aureus and allowed to dry. Disinfection caps containing 70% (v/v) isopropyl alcohol (IPA) were attached to the connectors for one, three or 7 days and were compared with needle-free connectors cleaned with 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) IPA. The number of S. aureus remaining on the injection ports was evaluated. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Results The application of the disinfection cap resulted in a significantly higher reduction in S. aureus than the 2% (w/v) CHG in 70% (v/v) IPA wipe, achieving a > 5 Log10 reduction in CFU at each time point. Conclusions The disinfection caps resulted in a significantly higher reduction in S.aureus on the injection ports when compared to the use of a 2% (w/v) CHG in 70% (v/v) IPA wipe. This offers an explanation for the lower rates of central-line associated bloodstream infection (CLABSI) associated with the use of disinfection caps reported in clinical studies.
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Affiliation(s)
- Anna L. Casey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| | - Tarja J. Karpanen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| | - Peter Nightingale
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| | - Tom S. J. Elliott
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
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Casey AL, Karpanen TJ, Nightingale P, Elliott TS. The risk of microbial contamination associated with six different needle-free connectors. ACTA ACUST UNITED AC 2018; 27:S18-S26. [PMID: 29368573 DOI: 10.12968/bjon.2018.27.2.s18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND needle-free connectors are widely used in clinical practice. The aim of this study was to identify any differences between microbial ingress into six different connectors (three neutral-displacement, one negative-displacement and two anti-reflux connectors). METHODS each connector underwent a 7-day clinical simulation involving repeated microbial contamination of the connector's injection ports with Staphylococcus aureus followed by decontamination and then saline flushes through each connector. The simulation was designed to be a surrogate marker for the potential risk of contamination in clinical practice. RESULTS increasing numbers of S. aureus were detected in the flushes over the 7 days of sampling despite adherence to a rigorous decontamination programme. Significant differences in the number of S. aureus recovered from the saline flush of some types of connectors were also detected. Two different durations (5- and 15-second) of decontamination of the injection ports with 70% isopropyl alcohol (IPA) wipes were also investigated. There was no significant difference between the median number of S. aureus recovered in the saline flushes following a 5-second (165.5, 95% CI=93-260) or a 15-second decontamination regimen (75, 10-190). CONCLUSIONS The findings suggest that there may be differences in the risk of internal microbial contamination with different types of connectors and that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices.
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Affiliation(s)
- Anna L Casey
- Clinical Research Scientist, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Tarja J Karpanen
- Clinical Research Nurse, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Peter Nightingale
- Statistician, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - Tom Sj Elliott
- Consultant Microbiologist, University Hospitals Birmingham NHS Foundation Trust, Birmingham
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Buchman A, Spapperi J, Leopold P. A New Central venous Catheter Cap: Decreased Microbial Growth and Risk for Catheter-Related Bloodstream Infection. J Vasc Access 2018; 10:11-21. [DOI: 10.1177/112972980901000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Catheter-related blood stream infection (CRBI) is a major cause of morbidity and mortality, and is a source of significant healthcare expenditures in patients that require central venous catheters for intravenous nutrition, chemotherapy, and other products. The source of many catheter-related infections is contamination of the catheter hub. Herein an antimicrobial catheter cap, the AB Cap is described. Methods The AB Cap device is a catheter cleaning device designed to keep needleless luer valves clean by encapsulating them in a cleaning solution. This device was evaluated using an in vitro model of hub contamination with Staphylococcus aureus, Staphylococcus epidermidis (S. epidermidis), Klebsiella pneumonia (K. pneumonia), Pseudomonas aeruginosa, Escherichia coli and Candida albicans (C. albicans). Following hub contamination on days 1, 3, 5 and 7, saline was infused through the AB Cap and effluent collected from the efferent end. The effluent fluid was cultured for the index organisms, and allowed to incubate in culture for up to 7 days. Negative control caps were not contaminated and positive controls lacked cleaning solution and were contaminated. Results Microbial growth developed for all index organisms, and generally within 1 day of culture growth following the first day of contamination (day 1) in effluent from all positive controls, while no growth occurred in effluent from negative controls. No growth of any organism occurred in any of the test items after the first day of contamination. Growth of three organisms was detected in two of the three test AB Caps following contamination day 3, after 1–4 days of incubation. All organisms could be cultured in the effluent from two of the three test items at contamination day 5, generally by the second day of incubation. One test item remained free of growth for the entire test period except for one organism. By day 7, this particular test item grew an additional organism and the testing was concluded. All positive growth test items remained positive on subsequent inoculations during culture of newly obtained effluent with the exception of test item A, from which effluent following inoculation on day 3 showed growth of S. epidermidis and K. pneumonia, but no growth for these organisms from effluent obtained on inoculation day 5. In addition, effluent from test item C showed growth of C. albicans from inoculation day 5, but no growth from effluent obtained on inoculation day 7. The growth of S. epidermidis from effluent of test item A from the day 3 inoculation, and C. albicans from effluent of test items B and C did not occur until day 4 of incubation, suggesting a very small amount of contamination. Conclusion An antimicrobial catheter cap is not a complete substitute for a proper catheter cleaning technique and other anti-infection precautions. However, we describe a unique catheter cap that significantly decreased the likelihood of a catheter-related infection from a non-cleaned cap in an in vitro model.
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Affiliation(s)
- A.L. Buchman
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL - USA
| | - J. Spapperi
- Medical Murray, Inc. North Barrington, IL - USA
| | - P. Leopold
- Medical Murray, Inc. North Barrington, IL - USA
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20
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The NeutraClear® needleless connector is equally effective against catheter colonization compared to MicroClave®. J Vasc Access 2017; 18:415-418. [PMID: 28777419 DOI: 10.5301/jva.5000775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Neutral-valve closed-system connectors can reduce the frequency of catheter colonization. Commercially available closed system connectors need to be tested and compared with each other to assess how they protect against contamination. We aimed to compare, in vitro, the efficacy of connectors NeutraClear® and MicroClave® against contamination under conditions of daily clinical practice. METHODS The model consisted of a set of 200 blood culture bottles (BCBs) with a cannula inserted (100 closed with NeutraClear® and 100 closed with MicroClave®) that were assessed in two experiments while instilling 1 mL of saline: manipulation based on the standard of care and manipulation using gloves impregnated with a 0.05 McFarland Staphylococcus aureus solution. The BCBs were incubated in a BACTEC System at 37°C under continuous shaking for up to 7 days. When a bottle turned positive, 100 µL of the fluid was cultured. The positivity rate and time to positivity of the BCB in each experiment was compared. RESULTS In the aseptic model in the NeutraClear® and MicroClave® groups, only 1 BCB and 2 BCBs were positive, respectively, (p = 0.55). In the contaminated model, all BCBs were positive in both groups at the end of the incubation time. We did not find differences for the MTP between NeutraClear® and MicroClave® (36.04 vs. 20.13 hours, p = 0.09). CONCLUSIONS The NeutraClear® needleless connector proved to be as efficient as the MicroClave® connector in the prevention of catheter colonization and migration of S. aureus from the surface to the inside of the hub in an in vitro model.
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21
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Conti A, Katzap RM, Poli-de-Figueiredo CE, Pagnussatti V, Figueiredo AE. Disinfection of the peritoneal dialysis bag medication port: Comparison of disinfectant agent and disinfection time. Nephrology (Carlton) 2017; 23:863-866. [PMID: 28703892 DOI: 10.1111/nep.13101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of the present study was to compare different disinfection techniques for the peritoneal dialysis bag medication port (MP). METHODS An experimental study was conducted testing different cleaning agents (70% alcohol vs 2% chlorhexidine) and time periods (5, 10 and 60 s) for disinfection of the MP. Five microorganisms (S. aureus, E. coli, A. baumannii and C. parapsilosis, CNS) were prepared for use as contaminants of the MP. MP were incubated in Tryptic soy broth at 36°C for 24 h, after which, they were seeded on a Biomérieux blood agar plate and incubated for 24 h at 36°C. RESULTS Three hundred peritoneal dialysis bags were analyzed regarding the time expose to the disinfectant showed a statistically significant difference in the number of culture positive (7/100) P = 0.001; Gram positive (6/100) P = 0.006 for 5 s, one positive culture and turbid bag with 10 s, while friction for 60 s showed all negative results. The comparison between disinfectant, alcohol or chlorhexidine, 150 bag in each group, showed that the ones disinfected with alcohol had five turbid bags, eight positive cultures and seven germs identified, while all bags disinfected with chlorhexidine were negative for all parameters, with a difference statistically significant (P = 0.004). CONCLUSION Our results suggest that the MP should be scrubbed with 2% chlorhexidine for at least 5 s; if alcohol 70% is used the length of friction should not be inferior to 10 s.
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Affiliation(s)
- Adriana Conti
- Postgraduate Program in Medicine and Health Sciences PPG-MCS, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Roberta M Katzap
- Postgraduate Program in Medicine and Health Sciences PPG-MCS, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Carlos E Poli-de-Figueiredo
- Postgraduate Program in Medicine and Health Sciences PPG-MCS, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Vany Pagnussatti
- Faculty of Pharmacy and Laboratory of Clinical Pathology, São Lucas Hospital of PUC, Porto Alegre, Brazil
| | - Ana E Figueiredo
- Postgraduate Program in Medicine and Health Sciences PPG-MCS, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Faculty of Nursing, Nutrition and Physiotherapy, PUCRS, Porto Alegre, Brazil
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Wax DB, Hill B. Design and Preliminary Testing of Novel Injection Port Contamination Barrier Devices. J Med Device 2017. [DOI: 10.1115/1.4036026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Prior studies have linked microbial contamination of intravenous (IV) ports and stopcocks with postoperative infections. Existing technologies to address contamination are not consistently utilized because of the time and effort they require. Herein, novel barrier devices were created that form a protective shell to passively prevent contact between injection sites and practitioner hands or environmental surfaces while still allowing rapid connection of a syringe for injection of medications via an opening in the shell. Prototypes were tested using a grossly contaminated environment and adenosine triphosphate (ATP)-bioluminescence assay. For eight pairs of unshielded versus shielded IV ports/stopcocks, average contamination was 4102 versus 35 RLU (p < 0.02), respectively, indicating that the devices could significantly reduce IV port/stopcock contamination.
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Affiliation(s)
- David B. Wax
- Department of Anesthesiology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029 e-mail:
| | - Bryan Hill
- Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029
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Caspari L, Epstein E, Blackman A, Jin L, Kaufman DA. Human factors related to time-dependent infection control measures: "Scrub the hub" for venous catheters and feeding tubes. Am J Infect Control 2017; 45:648-651. [PMID: 28214161 DOI: 10.1016/j.ajic.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of catheter hub decontamination protocols is a common practice to reduce central line-associated bloodstream infections. However, few data exist on the most effective disinfection procedure prior to hub access accounting for human factors and time-dependent practices in real time in the clinical setting. METHODS An observational design with a multimodal intervention was used in this study in a neonatal intensive care unit. Direct observations on nurse compliance of scrub times with decontamination when accessing of venous catheter and feeding tube hubs were conducted during 3 phases: (1) baseline period prior to any interventions; (2) during an educational intervention phase; and (3) during a timer intervention period when using a timing device, either an actual timer or music button. RESULTS Overall, both education and the timing device interventions increased the mean scrub time ± SD of venous catheter hubs. Mean baseline scrub times of 10 ± 5 seconds were lower compared with 23 ± 12 seconds after educational intervention (P < .002) and 31 ± 8 seconds with timer or music button use (P < .001). Timer intervention scrub time was also more effective than education alone (P < .05). Similar findings were observed with scrub times of feeding tubes. CONCLUSIONS Time-based infection control measures, such as scrubbing the hub, must be implemented with aids that qualify specific times to account for human factors, to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections.
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Alcohol Caps or Alcohol Swabs With and Without Chlorhexidine: An In Vitro Study of 648 Episodes of Intravenous Device Needleless Connector Decontamination. Infect Control Hosp Epidemiol 2017; 38:617-619. [DOI: 10.1017/ice.2016.330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Voor In 't Holt AF, Helder OK, Vos MC, Schafthuizen L, Sülz S, van den Hoogen A, Ista E. Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis. Int J Nurs Stud 2017; 69:34-40. [PMID: 28130997 DOI: 10.1016/j.ijnurstu.2017.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Microorganisms can intraluminally access a central venous catheter via the catheter hub. The catheter hub should be appropriately disinfected to prevent central line-associated bloodstream infections (CLABSIs). However, compliance with the time-consuming manual disinfection process is low. An alternative is the use of an antiseptic barrier cap, which cleans the catheter hub by continuous passive disinfection. OBJECTIVE To compare the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs. DESIGN Systematic review and meta-analysis. METHODS We systematically searched Embase, Medline Ovid, Web-of-science, CINAHL EBSCO, Cochrane Library, PubMed Publisher and Google Scholar until May 10, 2016. The primary outcome, reduction in CLABSIs per 1000 catheter-days, expressed as an incidence rate ratio (IRR), was analyzed with a random effects meta-analysis. Studies were included if 1) conducted in a hospital setting, 2) used antiseptic barrier caps on hubs of central lines with access to the bloodstream and 3) reported the number of CLABSIs per 1000 catheter-days when using the barrier cap and when using manual disinfection. RESULTS A total of 1537 articles were identified as potentially relevant and after exclusion of duplicates, 953 articles were screened based on title and abstract; 18 articles were read full text. Eventually, nine studies were included in the systematic review, and seven of these nine in the random effects meta-analysis. The pooled IRR showed that use of the antiseptic barrier cap was effective in reducing CLABSIs (IRR=0.59, 95% CI=0.45-0.77, P<0.001). CONCLUSIONS Use of an antiseptic barrier cap is associated with a lower incidence CLABSIs and is an intervention worth adding to central-line maintenance bundles.
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Affiliation(s)
- Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Onno K Helder
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital,, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Laura Schafthuizen
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sandra Sülz
- Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, The Netherlands
| | - Agnes van den Hoogen
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Clinical Health Science, University Utrecht, The Netherlands
| | - Erwin Ista
- Department of Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Curran E. Needleless connectors: the vascular access catheter's microbial gatekeeper. J Infect Prev 2016; 17:234-240. [PMID: 28989484 PMCID: PMC5102078 DOI: 10.1177/1757177416657164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022] Open
Abstract
Needleless connectors (NCs) are essential devices which connect to the end of vascular catheters and enable catheter access for infusion and aspiration. There are various different designs which make it difficult for purchasers to identify the features which present the least risk and greatest safety. The NC is the microbial gatekeeper for vascular catheters; how it is disinfected pre access determines if, and how many, organisms enter and how quickly biofilm will form. This paper will consider these design variations and how differences in antiseptic testing methods have made it difficult to determine the best antiseptic practice pre access. One specific design characteristic is considered: the fluid pathway. The NC's fluid pathway creates a flow which can be either direct to produce a laminar flow or indirect which creates a turbulent flow. At present, the evidence does not support there being an advantage for a specific fluid pathway design in reducing infection risks.
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Safdar N, Maki DG. Lost in Translation. Infect Control Hosp Epidemiol 2016; 27:3-7. [PMID: 16418979 DOI: 10.1086/500282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 12/20/2022]
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Flynn JM, Keogh SJ, Gavin NC. Sterile v aseptic non-touch technique for needle-less connector care on central venous access devices in a bone marrow transplant population: A comparative study. Eur J Oncol Nurs 2015; 19:694-700. [DOI: 10.1016/j.ejon.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
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Sauron C, Jouvet P, Pinard G, Goudreault D, Martin B, Rival B, Moussa A. Using isopropyl alcohol impregnated disinfection caps in the neonatal intensive care unit can cause isopropyl alcohol toxicity. Acta Paediatr 2015; 104:e489-93. [PMID: 26109465 DOI: 10.1111/apa.13099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
Abstract
AIM The safety of SwabCap alcohol impregnated disinfection caps was questioned in our unit because of malfunctions in luer access valves. We examined whether SwabCaps affected the integrity of two luer access valves and were associated with alcohol injected into the lines. METHODS Our bench test study included seven circuits using SmartSite or CARESITE valves exposed to two environmental temperatures. Passive circuits consisted of a 96-hour contact system using SwabCap without other interventions. Active circuits consisted of nine sham injections during a 24-hour period, with the SwabCap replaced after each injection. The active control circuit used isopropyl alcohol impregnated pads to disinfect valves. Isopropyl alcohol was measured at the extremity of all active circuits by gas chromatography. RESULTS The visual appearance of all SmartSite valves and 67% of the CARESITE valves was changed by SwabCap use. The mean isopropyl alcohol dosages were 52 mmol/L in the SmartSite and 8 mmol/L in the CARESITE at room temperature and 73 and 7 mmol/L, respectively, at 35°C. No alcohol was found in the control circuit. CONCLUSION The SwabCap altered the valves' appearance and allowed significant amounts of isopropyl alcohol to be injected. It should not be used for neonates without further research.
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Affiliation(s)
- Charlotte Sauron
- Neonatology; CHU Sainte-Justine; University of Montreal; Montreal QC Canada
- Neonatology; Hôpital Femme-Mère-Enfant; Hospices Civils de Lyon; Bron France
| | - Philippe Jouvet
- Pediatric Intensive Care; CHU Sainte-Justine; Montreal QC Canada
| | - Geneviève Pinard
- Quality, Security and Risk Counsel; CHU Sainte-Justine; Montreal QC Canada
| | | | | | - Bastien Rival
- Specialized Biochemistry Laboratory; CHU Sainte-Justine; Montreal QC Canada
| | - Ahmed Moussa
- Neonatology; CHU Sainte-Justine; University of Montreal; Montreal QC Canada
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Cole DC, Baslanti TO, Gravenstein NL, Gravenstein N. Leaving more than your fingerprint on the intravenous line: a prospective study on propofol anesthesia and implications of stopcock contamination. Anesth Analg 2015; 120:861-7. [PMID: 23749446 DOI: 10.1213/ane.0b013e318292ed45] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute care handling of IV stopcocks during anesthesia and surgery may result in contaminated IV tubing sets. In the context of widespread propofol use, a nutrient-rich hypnotic drug, we hypothesized that propofol anesthesia increases bacterial contamination of IV stopcocks and may compromise safety of IV tubing sets when continued to be used after propofol anesthesia. METHODS We conducted an in vitro trial by collecting IV tubing sets at the time of patient discharge from same-day ambulatory procedures performed with and without propofol anesthesia. These extension sets were then held at room temperature for 6, 24, or 48 hours. We cultured 50 samples at each interval for both cohorts. Quantitative cultures were done by aspirating the IV stopcock dead space and plating the aspirate on blood agar for colony count and speciation. RESULTS Positive bacterial counts were recovered from 17.3% of propofol anesthesia stopcocks (26/150) and 18.6% of nonpropofol stopcocks (28/150). At 6 hours, the average bacterial counts from stopcocks with visible residual propofol was 44 colony forming units (CFU)/mL, compared with 41 CFU/mL with no visible residual propofol and 37 CFU/mL in nonpropofol anesthesia stopcocks. There was a 100-fold increase in bacterial number in contaminated stopcock dead spaces at 48 hours after propofol anesthesia. This difference remained significant when comparing positive counts from stopcocks with no visible residual propofol and nonpropofol anesthesia (P = 0.034). CONCLUSIONS There is a covert incidence and degree of IV stopcock bacterial contamination during anesthesia which is aggravated by propofol anesthetic. Propofol anesthesia may increase risk for postoperative infection because of bacterial growth in IV stopcock dead spaces.
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Affiliation(s)
- Devon C Cole
- From the *Department of Anesthesiology, University of Florida College of Medicine; and †University of Florida College of Medicine, Gainesville, Florida
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Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review. Nurs Res Pract 2015; 2015:796762. [PMID: 26075093 PMCID: PMC4446481 DOI: 10.1155/2015/796762] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/19/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33-45% contaminated, and compliance with disinfection as low as 10%. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5-60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48-86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.
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Björkman L, Ohlin A. Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec reduced neonatal sepsis. Acta Paediatr 2015; 104:232-6. [PMID: 25399485 DOI: 10.1111/apa.12866] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/17/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit. METHODS We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci (CoNS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters. RESULTS During the control period before the initiative was launched, there were nine cases of CoNS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11). CONCLUSION Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by CoNS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed.
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Affiliation(s)
- Louise Björkman
- Department of Pediatrics; Faculty of Medicine and Health, Örebro University, SE 701 82; Örebro Sweden
| | - Andreas Ohlin
- Department of Pediatrics; Faculty of Medicine and Health, Örebro University, SE 701 82; Örebro Sweden
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Macklin D, Blackburn PL. Central Venous Catheter Securement: Using the Healthcare and Technology Synergy Model to Take a Closer Look. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.java.2014.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Proper securement provides a safe vascular access device environment for both patients and health care providers. Successful securement protects central venous catheters from several sources of failure until the end of therapy by preventing central venous catheter movement during all phases of care. Movement causes vein trauma, bacterial migration, distal tip location variation, loss of dressing integrity, and even total dislodgement. Any of these events can have serious consequences, including catheter-related bloodstream infection, thrombosis, delay of treatment, catheter replacement, and potential hemorrhage, all of which can be life-threatening events, and increase costs. We review patient issues, practice issues, and the types of securement currently used in clinical settings.
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Bryant KA, Zerr DM, Huskins WC, Milstone AM. The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Catheter-Associated Bloodstream Infections. Infect Control Hosp Epidemiol 2015; 31 Suppl 1:S27-31. [DOI: 10.1086/655994] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.
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Rupp ME, Yu S, Huerta T, Cavalieri RJ, Alter R, Fey PD, Van Schooneveld T, Anderson JR. Adequate Disinfection of a Split-Septum Needleless Intravascular Connector with a 5-Second Alcohol Scrub. Infect Control Hosp Epidemiol 2015; 33:661-5. [DOI: 10.1086/666337] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.Define optimum vascular catheter connector valve disinfection practices under laboratory and clinical conditions.Design.Prospective observational clinical survey and laboratory assessment of disinfection procedures.Setting.All adult inpatients at an academic healthcare center.Methods.In the clinical setting, contamination of needleless connectors was assessed in 6 weekly prevalence surveys in which the connector valves from central venous catheters (CVCs) in situ were cultured by pressing the connector diaphragm to an agar plate. Before culture, valves were disinfected by scrubbing the diaphragm with a 70% isopropyl alcohol pledget for 0, 5, 10, 15, or 30 seconds. In the laboratory, the diaphragms on 150 unused sterile connector valves were inoculated with 103, 105, or 108colony-forming units ofStaphylococcus epidermidisand allowed to dry. After disinfection of the diaphragms by scrubbing with a 70% isopropyl alcohol pledget for 0, 5, 10, 15, or 30 seconds, the valves were sampled by pressing the diaphragm to an agar plate.Results.In the clinical setting, 363 connector valves from patients with CVCs were sampled, and 66.7% of nondisinfected valves revealed bacterial contamination. After 5-second disinfection with an alcohol pledget, only 1 (1.4%) of 71 yielded microbial growth (P< .005). In the laboratory, at the 103and 105inoculum, all connector valves yielded sterile cultures when scrubbed for 5 or more seconds (P< .001). At the 108inoculum, 2 (20%) of 10 connector valves yielded minimal growth ofS. epidermidis.Conclusions.A 5-second scrub with a 70% isopropyl alcohol pledget yields adequate disinfection of a split-septum intravascular catheter connector valve under clinical and laboratory conditions.
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Salgado CD, Chinnes L, Paczesny TH, Cantey JR. Increased Rate of Catheter-Related Bloodstream Infection Associated With Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care Hospital. Infect Control Hosp Epidemiol 2015; 28:684-8. [PMID: 17520541 DOI: 10.1086/516800] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 09/13/2006] [Indexed: 11/03/2022]
Abstract
Objective.To determine whether introduction of a needleless mechanical valve device (NMVD) at a long-term acute care hospital was associated with an increased frequency of catheter-related bloodstream infection (BSI).Design.For patients with a central venous catheter in place, the catheter-related BSI rate during the 24-month period before introduction of the NMVD, a period in which a needleless split-septum device (NSSD) was being used (hereafter, the NSSD period), was compared with the catheter-related BSI rate during the 24-month period after introduction of the NMVD (hereafter, the NMVD period). The microbiological characteristics of catheter-related BSIs during each period were also compared. Comparisons and calculations of relative risks (RRs) with 95% confidence intervals (CIs) were performed using χ2 analysis.Results.Eighty-six catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during the study period. The rate of catheter-related BSI during the NMVD period was significantly higher than that during the NSSD period (5.95 vs 1.79 infections per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88–3.83]; P < .001). A significantly greater percentage of catheter-related BSIs during the NMVD period were caused by gram-negative organisms, compared with the percentage recorded during the NSSD period (39.5% vs 8%; P = .007). Among catheter-related BSIs due to gram-positive organisms, the percentage caused by enterococci was significantly greater during the NMVD period, compared with the NSSD period (54.8% vs 13.6%; P = .004). The catheter-related BSI rate remained high during the NMVD period despite several educational sessions regarding proper use of the NMVD.Conclusions.An increased catheter-related BSI rate was temporally associated with use of a NMVD at the study hospital, despite several educational sessions regarding proper NMVD use. The current design of the NMVD may be unsafe for use in certain patient populations.
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MESH Headings
- Bacteremia/epidemiology
- Bacteremia/etiology
- Bacteremia/microbiology
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Catheterization, Central Venous/nursing
- Catheters, Indwelling/microbiology
- Cross Infection/epidemiology
- Cross Infection/microbiology
- Cross Infection/prevention & control
- Disease Outbreaks/prevention & control
- Education, Nursing, Continuing
- Gram-Negative Bacteria/isolation & purification
- Gram-Negative Bacterial Infections/epidemiology
- Gram-Negative Bacterial Infections/microbiology
- Gram-Negative Bacterial Infections/prevention & control
- Hospitals, Special/standards
- Hospitals, Special/statistics & numerical data
- Humans
- Long-Term Care/standards
- Needlestick Injuries/prevention & control
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/standards
- Sentinel Surveillance
- South Carolina/epidemiology
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Affiliation(s)
- Cassandra D Salgado
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC 29425, USA.
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An In Vitro Comparison of Microbial Ingress Into 8 Different Needleless IV Access Devices. JOURNAL OF INFUSION NURSING 2015; 38:18-25. [DOI: 10.1097/nan.0000000000000082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rundjan L, Rohsiswatmo R, Paramita TN, Oeswadi CA. Closed catheter access system implementation in reducing the bloodstream infection rate in low birth weight preterm infants. Front Pediatr 2015; 3:20. [PMID: 25853110 PMCID: PMC4360570 DOI: 10.3389/fped.2015.00020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/25/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bloodstream infection (BSI) is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital. OBJECTIVE To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight. METHODS Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2 weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture. RESULTS Closed catheter access system implementation gave a protective effect toward the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011-0.85, p = 0.026). Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227-90.662, p = 0.026). BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group. CONCLUSION The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device, and appropriate frequency of connector change should be done simultaneously.
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Affiliation(s)
- Lily Rundjan
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia , Jakarta , Indonesia
| | - Rinawati Rohsiswatmo
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia , Jakarta , Indonesia
| | - Tiara Nien Paramita
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia , Jakarta , Indonesia
| | - Chrissela Anindita Oeswadi
- Neonatology Division, Child Health Department, Cipto Mangunkusumo Hospital - University of Indonesia , Jakarta , Indonesia
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The Role of Antifungals against Candida Biofilm in Catheter-Related Candidemia. Antibiotics (Basel) 2014; 4:1-17. [PMID: 27025612 PMCID: PMC4790322 DOI: 10.3390/antibiotics4010001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/09/2014] [Indexed: 12/26/2022] Open
Abstract
Catheter-related bloodstream infection (C-RBSI) is one of the most frequent nosocomial infections. It is associated with high rates of morbidity and mortality. Candida spp. is the third most common cause of C-RBSI after coagulase-negative staphylococci and Staphylococcus aureus and is responsible for approximately 8% of episodes. The main cause of catheter-related candidemia is the ability of some Candida strains-mainly C. albicans and C. parapsilosis-to produce biofilms. Many in vitro and in vivo models have been designed to assess the activity of antifungal drugs against Candida biofilms. Echinocandins have proven to be the most active antifungal drugs. Potential options in situations where the catheter cannot be removed include the combination of systemic and lock antifungal therapy. However, well-designed and -executed clinical trials must be performed before firm recommendations can be issued.
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Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. Am J Infect Control 2014; 42:1274-7. [PMID: 25465256 DOI: 10.1016/j.ajic.2014.09.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) result in increased length of stay, cost, and patient morbidity and mortality. One CLABSI prevention method is disinfection of intravenous access points. The literature suggests that placing disinfectant caps over needleless connectors decreases CLABSI risk. METHODS A quasi-experimental intervention study was conducted in a >430-bed trauma I center. In addition to an existing standard central line bundle, a new intervention consisting of a luer-lock disinfectant cap with 70% alcohol was implemented in all intravenous (IV) needleless connectors on patients with peripheral and central lines. Compliance to the disinfectant cap was monitored weekly. A generalized linear model using a Poisson distribution was fit to determine if there were significant relationships between CLABSIs and disinfectant cap use. Impacts on costs were also examined. RESULTS The rate of CLABSI decreased following implementation of the disinfectant cap. The incidence rate ratios (.577, P = .004) for implementing the disinfectant caps was statistically significant, indicating that the rate of patient infections decreased by >40%. Increased compliance rates were associated with lower infection rates. Disinfectant cap use was associated with an estimated savings of almost $300,000 per year in the hospital studied. CONCLUSIONS Use of a disinfectant cap on IV needleless connectors in addition to an existing standard central line bundle was associated with decreased CLABSI and costs.
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Guembe M, Pérez-Granda MJ, Alcalá L, Martín-Rabadán P, Bouza E. A simple and easy in vitro model to test the efficacy of IV lines' needleless connectors against contamination. Intensive Care Med Exp 2014; 2:27. [PMID: 26266924 PMCID: PMC4513010 DOI: 10.1186/s40635-014-0027-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/14/2014] [Indexed: 11/24/2022] Open
Abstract
Background Hub colonization after manipulation is responsible for 29% to 60% of catheter-related bloodstream infections (C-RBSI). Prevention can be achieved by the use of hub connectors, but its efficacy is generally based on instillation of high concentrations of microorganisms, which do not reflect the real contamination in daily practice. Our purpose was to create an in vitro model lasting long enough to be used for the comparison of the efficacy between various connectors against contamination simulating the real daily handling. Methods The model consisted of 40 blood culture bottles with an inserted cannula with a needle-free closed connector. Twice a day, each line was manipulated while instilling 1 mL of two different fluids (saline and propofol). We manipulated the bottles as follows: ten bottles with clean gloves and disinfecting connectors with alcohol (controls), ten bottles with hands (no gloves), ten bottles with gloves impregnated with a 0.5 McFarland (MF) solution of Staphylococcus aureus (SA), and ten bottles with gloves impregnated with a 0.05 MF solution of SA. The bottles were incubated in a BACTEC System at 37°C under continuous agitation up to 10 days. When a bottle turned positive, 100 μL of the fluid was cultured and incubated followed by microorganism identification using standard procedures. Results Overall, all bottles in the control group were negative at the end of the incubation time. In the three contamination experiments, almost all (38/40) bottles were positive during the incubation time. We only found differences regarding the median time to positivity (interquartile range (IQR)) between saline and propofol in the manipulation with SA 0.05 MF: 240 h (154.82 to 360.00) vs. 66 h (58.01 to 69.11), p = 0.008. Conclusions A daily connector handling with 0.05 McFarland S. aureus solution while instilling saline proved to be a useful model lasting long enough to be used for the comparison of the efficacy of different types of closed needleless connectors against contamination. Electronic supplementary material The online version of this article (doi:10.1186/s40635-014-0027-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007, Madrid, Spain,
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Taylor JE, McDonald SJ, Tan K. Prevention of central venous catheter-related infection in the neonatal unit: a literature review. J Matern Fetal Neonatal Med 2014; 28:1224-30. [PMID: 25076387 DOI: 10.3109/14767058.2014.949663] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Central venous catheter infections are the leading cause of healthcare-associated bloodstream infections and contribute significantly to mortality and morbidity in neonatal intensive care units. Moreover, infection poses significant economic consequence which increased hospital costs and increased length of hospital stay. Prevention strategies are detailed in guidelines published by the Centers for Disease Control and Prevention (CDC) in the United States; nevertheless, recent surveys in neonatal units in the United States, and Australia and New Zealand demonstrate these are not always followed. This review discusses the numerous evidence-based strategies to prevent catheter infections including hand hygiene, maximal sterile barriers during insertion, skin disinfection, selection of insertion site, dressings, aseptic non-touch technique, disinfection of catheter hubs/ports, administration set management, prompt removal of catheter, antibiotic locks, systemic antibiotic prophylaxis and chlorhexidine bathing. Furthermore, it will describe different strategies that can be implemented into clinical practice to reduce infection rates. These include the use of care bundles including checklists, education and the use of CVC teams.
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Needleless closed system does not reduce central venous catheter-related bloodstream infection: a retrospective study. Int Surg 2014; 98:88-93. [PMID: 23438283 DOI: 10.9738/cc132.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The needleless closed system (NCS) has been disseminated in several clinical fields to prevent central venous catheter-related bloodstream infection (CVC-RBSI), in place of the conventional Luer cap system (LCS). The purpose of this study is to examine whether NCS is really superior to conventional LCS for prevention of CVC-RBSI. Between May 2002 and December 2008, 1767 patients received CVC in our department. The time interval from insertion to development of CVC-RBSI was compared retrospectively between selected patients who were treated using the conventional LCS (group 1, n = 89, before June 2006) and the NCS (group 2, n = 406, June 2006 and after). Kaplan-Meier analysis revealed no significant difference in the time interval from insertion to development of CVC-RBSI between the two groups. NCS does not reduce CVC-RBSI in adult colorectal cancer patients who undergo CVC insertion.
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Sustained reduction of central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance. Am J Infect Control 2014; 42:723-30. [PMID: 24856587 DOI: 10.1016/j.ajic.2014.03.353] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Central venous catheter use is common outside the intensive care units (ICUs), but prevention in this setting is not well studied. We initiated surveillance for central line-associated bloodstream infections (CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of CLABSIs across multiple hospitals. METHODS This project was constructed as a prospective preintervention-postintervention design. The project comprised 3 phases (preintervention [baseline], intervention, and postintervention) over a 4.5-year period (2008-2012) and was implemented through a collaborative of 37 adult non-ICU wards at 6 hospitals in the Rochester, NY area. The intervention focused on engagement of nursing staff and leadership, nursing education on line care maintenance, competence evaluation, audits of line care, and regular feedback on CLABSI rates. Quarterly rates were compared over time in relation to intervention implementation. RESULTS The overall CLABSI rate for all participating units decreased from 2.6/1000 line-days preintervention to 2.1/1,000 line-days during the intervention and to 1.3/1,000 line-days postintervention, a 50% reduction (95% confidence interval, .40-.59) compared with the preintervention period (P .0179). CONCLUSION A multipronged approach blending both the adaptive and technical aspects of care including front line engagement, education, execution of best practices, and evaluation of both process and outcome measures may provide an effective strategy for reducing CLABSI rates outside the ICU.
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Abstract
This article focuses on the pathogenesis, diagnosis, prevention, and management of infectious complications of intravascular cannulation and fluid infusion. Although continuous vascular access is one of the most essential modalities in modern-day medicine, there is a substantial and underappreciated potential for producing iatrogenic complications, the most important of which is blood-borne infection. Clinicians often fail to consider the diagnosis of infusion-related sepsis because clinical signs and symptoms are indistinguishable from bloodstream infections arising from other sites. Understanding and consideration of the risk factors predisposing patients to infusion-related infections may guide the development and implementation of control measures for prevention.
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Affiliation(s)
- Anand Kumar
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Holroyd JL, Paulus DA, Rand KH, Enneking FK, Morey TE, Rice MJ. Universal intravenous access cleaning device fails to sterilize stopcocks. Anesth Analg 2014; 118:333-343. [PMID: 24445634 DOI: 10.1213/ane.0000000000000059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Contamination of a central venous catheter may occur through use of conventional open-lumen stopcock devices (COLDs), or disinfectable, needleless, closed connectors (DNCCs). We investigated the effectiveness of a new universal IV access cleaning device (Site-Scrub) compared with 70% isopropyl alcohol prep pads for sanitizing COLDs or DNCCs inoculated with common catheter-associated pathogens. METHODS Site-Scrub was compared with 70% alcohol prep pads for sanitizing contaminated female Luer lock COLD or DNCC filled with sterile saline or propofol and 2 common bacterial central venous catheter contaminants (Staphylococcus epidermidis or Pseudomonas aeruginosa). Devices were contaminated using a glove touch (COLD and DNCC) or syringe tip (COLD). The primary end point of the study was colony-forming units (CFU) after 24 hours. RESULTS The use of glove touch contamination, the contaminants, S epidermidis and P aeruginosa, produced CFU in saline-filled COLDs treated with the Site-Scrub, but not in those treated with alcohol pads (P < 0.001). Similar results were observed with propofol-filled COLDs (P < 0.001). For DNCCs filled with saline or propofol, both alcohol and Site-Scrub effectively reduced CFU growth compared with contaminated controls (P < 0.001). When COLDs were contaminated by treated syringe tips, there was no significant evidence of reduction in CFU growth by using either alcohol pads or Site-Scrub compared with contaminated controls. CONCLUSIONS These data suggest that when the inner surface of the COLD is contaminated, both alcohol pads and Site-Scrub were not significantly effective in decontaminating the COLD. When the COLD rim is contaminated, however, alcohol pads outperform Site-Scrub. DNCCs were uniformly decontaminated with either treatment. Future work should focus on better access systems because current COLDs are difficult to decontaminate.
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Affiliation(s)
- Julie L Holroyd
- From the Departments of Anesthesiology and Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida; Deceased
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Bouza E, Guembe M, Pérez-Granda MJ. Innovative Strategies for Preventing Central-Line Associated Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-013-0001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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