Impact of universal disinfectant cap implementation on central line–associated bloodstream infections


      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.


      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.


      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.


      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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      1. Shekelle PG, Wachter RM, Pronovost PJ, Schoelles K, McDonald KM, Dy SM, et al. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Agency for Healthcare Research and Quality Web site. 2013. Available from: Accessed May 22, 2014.

        • Sagana R.
        • Hyzy R.C.
        Achieving zero central line–associated bloodstream infection: rates in your intensive care unit.
        Crit Care Clin. 2013; 29: 1-9
      2. O'Grady NP, Alexander M, Burns LA, Dellinger P, Garland J, Heard SO, et al. Guidelines for prevention of intravascular catheter-related infections, 2011. Centers for Disease Control and Prevention. Available from: Accessed April 23, 2014.

        • Marschall J.
        • Mermel L.A.
        • Classen D.
        • Arias K.M.
        • Podgorny K.
        • Anderson D.J.
        • et al.
        Strategies to prevent central line-associated bloodstream.
        Infect Control Hosp Epidemiol. 2008; 29: S22-S30
        • Jeffries H.E.
        • Mason W.
        • Brewer M.
        • Oakes K.L.
        • Muñoz E.I.
        • Gornick W.
        • et al.
        Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative.
        Infect Control Hosp Epidemiol. 2009; 30: 645-651
        • Shannon R.P.
        • Patel B.
        • Cummins D.
        • Shannon A.H.
        • Ganguli G.
        • Lu Y.
        Economics of central line-associated bloodstream infections.
        Am J Med Qual. 2006; 21: 7S-16S
      3. Doellman D. The role of technology in reducing risks associated with CRBSI. Ivera Medical Corporation Web site. Available from: (2011). Accessed May 22, 2014.

        • Menyhay S.Z.
        • Maki D.B.
        Disinfection of needless 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; 17: 23-27
        • Oto J.
        • Imanaka H.
        • Konno M.
        • Nakataki E.
        • Nishimura M.
        A prospective clinical trial on prevention of catheter contamination using the hub protection cap for needleless injection device.
        Am J Infect Control. 2011; 39: 309-313
        • McAfee N.
        • Seidel K.
        • Watkins S.
        • Flynn J.T.
        A continuous quality improvement project to decrease hemodialysis catheter infections in pediatric patients: use of a closed luer-lock access cap.
        Nephrol Nurs J. 2010; 37: 541-544
        • Wright M.O.
        • Tropp J.
        • Schora D.M.
        • Dillon-Grant M.
        • Peterson K.
        • Boehm S.
        • et al.
        Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection.
        Am J Infect Control. 2013; 4: 33-38
        • Shadish W.R.
        • Cook T.D.
        • Campbell D.T.
        Experimental and quasi-experimental designs for generalized causal inference.
        Houghton Mifflin, Boston [MA]2002
      4. Food and Drug Administration. Ivera Medical Curos 510(k) notification. (2012). Available from: Accessed May 22, 2014.

        • Latif A.
        • Majid H.
        • Mahmood F.
        • Pronovost P.
        • Dowdy D.
        Cost effectiveness of reducing CLABSI in the limited resource setting of developing countries.
        Crit Care Med. 2013; 41: s122-s123
        • IBM Corp
        IMB SPSS statistics for Windows, Version 22.0.
        IBM Corp, Armonk [NY]2013
        • Hilbe J.M.
        Negative binomial regression.
        2nd ed. Cambridge University Press, New York [NY]2011
        • Blot K.
        • Bergs J.
        • Vogelaers D.
        • Blot S.
        • Vandijck D.
        Prevention of central-line associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis.
        Clin Infect Dis. 2014; 59: 96-105
        • Sweet M.A.
        • Cumpston A.
        • Briggs F.
        • Hamadani C.M.
        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.
        Am J Infect Control. 2012; 40: 931-934
      5. Johns Hopkins Medicin, Armstrong Institute for Patient Safety and Quality. CLABSI toolkit. 2008; Available from: Accessed May 20, 2014.