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Methods for microbial needleless connector decontamination: A systematic review and meta-analysis

  • Julie M. Flynn
    Correspondence
    Address correspondence to Julie M. Flynn, RN, MAdvPrac, Nursing and Midwifery Research Centre, Level 2, Building 34, Royal Brisbane & Women's Hospital, Butterfield St, Herston 4029, QLD, Australia.
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia

    Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
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  • Emily N. Larsen
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
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  • Samantha Keogh
    Affiliations
    Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia

    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
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  • Amanda J. Ullman
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
    Search for articles by this author
  • Claire M. Rickard
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia

    Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
    Search for articles by this author
Published:February 27, 2019DOI:https://doi.org/10.1016/j.ajic.2019.01.002

      Highlights

      • To our knowledge this is the first systematic review to include chlorhexidine wipes.
      • Review evaluated 12 nonrandomized studies of moderate quality.
      • 2% chlorhexidine in alcohol wipes had less risk of CABSI compared to alcohol wipes.
      • 70% alcohol caps associated with reduced risk of CABSI compared to alcohol wipes.
      • Randomized controlled trials are needed to confirm or refute these results.

      Background

      The objective of this review was to compare the effectiveness of connector decontamination with 70% alcohol wipes, alcoholic chlorhexidine gluconate wipes, or alcohol impregnated caps to prevent catheter-associated bloodstream infection (CABSI).

      Methods

      A systematic search was conducted in CINAHL, Cochrane Central Register of Controlled Trials, Medline, and PubMed. The primary outcome was CABSI, with randomized and observational studies included. The inclusion criteria were: English language, any age group, no date limitations, and reporting connector decontamination interventions to prevent CABSI. The exclusion criteria were: multimodal interventions, letters, and conference abstracts. Quality assessment with the Newcastle-Ottawa Scale, a narrative synthesis, and meta-analysis were conducted. Pooled data used a random effects model for pair-wise comparisons, due to clinical heterogeneity. Statistical heterogeneity was investigated by visual model inspection, χ², and I² statistics.

      Results

      Ten studies compared 70% alcohol wipes with 70% alcohol-impregnated caps, and 2 studies (n = 1,216) tested an alcoholic chlorhexidine gluconate wipe. Alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.28; 95% confidence interval, 0.20-0.39). Alcohol-impregnated caps were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.43; 95% confidence interval, 0.28-0.65). Studies were of low to moderate quality.

      Conclusions

      Alcohol impregnated caps and alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes. This requires confirmation in randomized controlled trials.

      Key Words

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