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Boissière C, Bacle A, Pelletier R, Le Bouedec D, Gicquel T, Lurton Y, Le Daré B. In vitro assessment of isopropanol leakage from antiseptic barrier caps into commonly used needleless connectors. Infect Control Hosp Epidemiol 2024; 45:576-582. [PMID: 38213184 PMCID: PMC11027082 DOI: 10.1017/ice.2023.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit. METHODS We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector. RESULTS The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg). CONCLUSION The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.
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Affiliation(s)
- Camille Boissière
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
| | - Astrid Bacle
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), Rennes, France
| | - Romain Pelletier
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
| | - Diane Le Bouedec
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
| | - Thomas Gicquel
- Laboratoire de Toxicologie biologique et médico-légale, CHU Pontchaillou, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
| | - Yves Lurton
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
| | - Brendan Le Daré
- Centre Hospitalier Universitaire de Rennes, Service Pharmacie, Rennes, France
- University of Rennes, INSERM, INRAE, CHU Rennes, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes, France
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SHEA Neonatal Intensive Care Unit (NICU) White Paper Series: Practical approaches for the prevention of central-line-associated bloodstream infections. Infect Control Hosp Epidemiol 2022; 44:550-564. [PMID: 35241185 DOI: 10.1017/ice.2022.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This document is part of the "SHEA Neonatal Intensive Care Unit (NICU) White Paper Series." It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: "Practical approaches to Clostridioides difficile prevention" published in August 2018 and "Practical approaches to Staphylococcus aureus prevention," published in September 2020.
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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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