Advertisement

A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: A pediatric single center before/after study on a hemopoietic stem cell transplant ward

      Background

      Some catheter-related bloodstream infections originate from catheter connectors; therefore, improved antisepsis of these might be expected to reduce the incidence of such infections.

      Methods

      In this observational before/after study at a pediatric tertiary referral hospital, inpatients up to 16 years old undergoing hemopoietic stem cell transplants were studied. Catheter connection antisepsis was changed from 70% isopropanol alone to 2% chlorhexidine in 70% isopropanol. Numbers of catheter-related bloodstream infections before and after the change were monitored as were the numbers of catheter days experienced by patients.

      Results

      The infection rate before the change was 12 per 1000 catheter-days, and, following the change, this fell to 3 per 1000 catheter-days (P=.004). Similar falls followed the introduction of chlorhexidine to other wards.

      Conclusion

      The introduction of chlorhexidine was followed by a profound, sustained fall in catheter-related infections. The results support the 2007 United Kingdom guidelines recommending 2% chlorhexidine in 70% isopropanol as a disinfectant of needleless connectors and hubs of central venous catheters.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rosenthal V.D.
        • Maki D.G.
        • Salomao R.
        • Álvarez-Moreno C.
        • Mehta Y.
        • Higuera F.
        • et al.
        • International Nosocomial Infection Control Consortium
        Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.
        Ann Intern Med. 2006; 145: 582-589
        • Arnow P.M.
        • Quimosing E.M.
        • Beach M.
        Consequences of intravascular catheter sepsis.
        Clin Infect Dis. 1993; 16: 778-784
        • Mermel L.A.
        Prevention of intravascular catheter-related infections.
        Ann Intern Med. 2000; 132: 391-402
        • Sitges-Serra A.
        • Puig P.
        • Linares J.
        • Perez J.L.
        • Farrero N.
        • Jaurrieta E.
        • et al.
        Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition.
        J Parenter Enteral Nutr. 1984; 8: 668-672
        • McDonald L.C.
        • Banerjee S.N.
        • Jarvis W.R.
        Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needle less device and intermittent intravenous therapy.
        Infect Control Hosp Epidemiol. 1998; 19: 772-777
        • Rupp M.E.
        • Sholtz L.A.
        • Jourdan D.R.
        • Marion N.D.
        • Tyner L.K.
        • Fey P.D.
        Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.
        Clin Infect Dis. 2007; 44: 1408-1414
        • Salzman M.B.
        • Isenberg H.D.
        • Rubin L.G.
        Use of disinfectants to reduce microbial contamination of hubs of vascular catheters.
        J Clin Microbiol. 1993; 31: 475-479
        • O'Grady N.P.
        • Alexander M.
        • Dellinger E.P.
        • Gerberding J.L.
        • Heard S.O.
        • Maki D.G.
        • et al.
        Guidelines for the prevention of intravascular catheter-related infections.
        MMWR Recomm Rep. 2002; 51: 1-29
        • Pratt R.J.
        • Pellowe C.M.
        • Wilson J.A.
        • Loveday H.
        • Harper P.
        • Jones S.
        • et al.
        Epic 2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.
        J Hosp Infect. 2007; 65: S1-64
        • Casey A.L.
        • Worthington T.
        • Lambert P.A.
        • Quinn D.
        • Faroqui M.H.
        • Elliott T.S.J.
        A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow connector.
        J Hosp Infect. 2003; 54: 288-293
        • Maki D.G.
        • Ringer M.
        • Alvarado C.J.
        Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.
        Lancet. 1991; 338: 339-343
        • Raad I.
        • Costerton W.
        • Sabharwal U.
        • Sacilowski M.
        • Anaissie E.
        • Bodey G.P.
        Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement.
        J Infect Dis. 1993; 168: 400-407
        • Segura M.
        • Alvarez-Lerma F.
        • Tellado J.M.
        • Jimenez-Ferreres J.
        • Oms L.
        • Rello J.
        • et al.
        A clinical trial on the prevention of catheter-related sepsis using a new hub model.
        Ann Surg. 1996; 223: 363-369
        • Menyhay S.Z.
        • Maki D.G.
        Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap.
        Infect Control Hosp Epidemiol. 2006; 27: 23-27
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • Sinopoli D.
        • Chu H.
        • Cosgrove S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2007; 355: 2725-2732
        • Pronovost P.
        Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project.
        Am J Infect Control. 2008; 36 (e1-5): S171