Advertisement

Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line–associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit

      Background

      A major risk factor for the development of bloodstream infection is the presence of a central venous catheter (CVC), especially in immunocompromised patients. CVC hub contamination is a risk factor for central line–associated bloodstream infection (CLABSI).

      Methods

      This observational before–after trial in a tertiary care hospital's oncology unit included adult patients with a CVC. During the intervention period, the practice of central line hub care was changed from cleaning with alcohol wipes to using alcohol-impregnated port protectors. To accommodate the protectors, the needless hubs were changed to a neutral pressure connector. The intervention period (January-July 2010) was compared with a historical control (January-December 2009).

      Results

      A total of 3,005 central line-days and 1 CLABSI (a rate of 0.3 infections/1,000 central line-days) were documented during the intervention period, compared with 6,851 central line-days and 16 CLABSIs (2.3 infections/1,000 central line-days) during the control period (relative risk, 0.14; 95% confidence interval [CI], 0.02-1.07; P = .03). The rate of contaminated blood cultures (CBCs) from central lines was 2.5% (17 of 692) during the control period, but only 0.2% (1 of 470) during the intervention period (relative risk, 0.09; 95% CI, 0.01-0.65; P = .002).

      Conclusions

      The implementation of alcohol-impregnated port protectors and needleless neutral pressure connectors significantly reduced the rates of CLABSIs and CBCs in our oncology patient population.

      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

        • Klevens R.
        • Edwards J.R.
        • Richards C.L.
        • Horan T.C.
        • Gaynes R.P.
        • Pollock D.A.
        • et al.
        Estimating healthcare-associated infections and deaths in US hospitals, 2002.
        Public Health Rep. 2007; 122: 160-166
        • Centers for Disease Control and Prevention
        Vital signs: central line–associated blood stream infections—United States, 2001, 2008, 2009.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 243-248
        • Maki D.G.
        • Kluger D.M.
        • Crnich C.J.
        The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies.
        Mayo Clin Proc. 2006; 81: 1159-1171
        • Raad I.
        • Hanna H.
        • Maki D.G.
        Intravascular catheter–related infections: advances in diagnosis, prevention, and management.
        Lancet Infect Dis. 2007; 7: 645-657
        • 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.
        Morb Mortal Recomm Rep. 2002; 51: 1-26
        • Marschall J.
        • Mermel L.A.
        • Classen D.
        • Arias K.M.
        • Podgorny K.
        • Anderson D.J.
        • et al.
        Strategies to prevent central line–associated bloodstream infections in acute care hospitals.
        Infect Control Hosp Epidemiol. 2008; 29: S22-S30
        • Pratt R.J.
        • Pellowe C.M.
        • Wilson J.A.
        • Loveday H.P.
        • Harper P.J.
        • Jones S.R.L.J.
        • et al.
        Epic2: guidelines for preventing infections associated with the use of central venous access devices (CVAD).
        J Hosp Infect. 2007; 65: S33-S59
        • Association for Professionals in Infection Control and Epidemiology
        Guide to the elimination of catheter-related bloodstream infections.
        Association for Professionals in Infection Control and Epidemiology, Washington [DC]2009
        • Joint Commission
        Accreditation program: National Patient Safety Goals.
        (NPSG.07.4.01) Joint Commission, Washington [DC]2008
        • 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
        • Edwards J.R.
        • Peterson K.D.
        • Yi Mu
        • Banerjee S.
        • Allen-Bridson K.
        • Morrell G.
        • et al.
        National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009.
        Am J Infect Control. 2009; 37: 783-805
        • Horan T.C.
        • Andrus M.L.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 36: 309-332
        • Edmond M.B.
        • Wallace S.E.
        • McClish D.K.
        • Pfaller M.A.
        • Jones R.N.
        • Wenzel R.P.
        Nosocomial infections in the United States hospitals: a three-year analysis.
        Clin Infect Dis. 1999; 26: 239-244
        • Wisplinghoff H.W.
        • Bischoff T.
        • Tallent S.M.
        • Seifert H.
        • Wenzel R.P.
        • Edmond M.B.
        Nosocomial bloodstream infections in US hospitals of 24,179 cases from a prospective nationwide surveillance study.
        Clin Infect Dis. 2004; 39: 309-317
        • Hidron A.I.
        • Edwards J.R.
        • Patel J.
        • Horan T.C.
        • Sievet D.M.
        • Pollock D.A.
        • et al.
        NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007.
        Infect Control Hosp Epidemiol. 2008; 29: 996-1011
        • 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
        • Kaler W.
        • Chinn R.
        Successful disinfection of needleless access ports: a matter of time and friction.
        J Assoc Vasc Access. 2007; 12: 140-147
        • 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
        • Weinbaum F.I.
        • Lavie S.
        • Danek M.
        • Sixsmith D.
        • Heinrich G.F.
        • Mills S.S.
        Doing it right the first time: quality improvement and the contaminant blood culture.
        J Clin Microbiol. 1997; 35: 563-565
        • Bates D.W.
        • Goldman L.
        • Lee T.H.
        Contaminant blood cultures and resource utilization: the true consequences of false-positive results.
        JAMA. 1991; 265: 365-369
        • Bouza E.
        • Munoz P.
        • Lopez-Rodriguez J.
        • Perez M.J.
        • Rincon C.
        • Rabadan P.M.
        • et al.
        A needleless closed-system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study.
        J Hosp Infect. 2003; 54: 279-287