Although the term CRBSI is the more valid infection-rate indicator as it is based on blood and catheter-tip culture results from samples taken from the actual catheter and in different locations of the venous circulation, making it arguably more scientific than CLABSI, it is typically used for clinical research rather than surveillance purposes. 
Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Like Madni and Eastman (2018), the experts attend the round table were trying to devise an umbrella term to cover both classifications. Funding for this study was provided by 3M. 3M was not involved in the collection, analysis, and interpretation of data and the preparation, submission, and review of this manuscript. van Cott H. Human errors: their causes and reduction. An identical number of control needle-free connectors which were contaminated as above and which were not decontaminated were also similarly studied and acted as positive controls for each sampling point. Disinfection caps were attached to the needlefree-connectors for 1, 3 or 7 days and were compared with needle-free connectors cleaned with a 2% (w/v) CHG in 70% (v/v) IPA wipe. Infect Control Hosp Epidemiol. Health professionals are more likely to pay attention to a catheter lumen if there is a brightly coloured cap protecting the hub from clinical misuse. Needlefree connectors (NFCs) can protect against contamination of the distal hub, NFCs need to be disinfected before use. Am J Infect Control. Similarly, if the disinfection caps were employed in the inpatient clinical scenario they would be accessed and replaced more frequently. Ramirez C, Lee AM, Welch K. Central venous catheter protective connector caps reduce intraluminal catheter-related infection. It is widely used in health care in the UK, particularly in critical care, to monitor acute central venous catheter infection rates, as they can be reported to the Department of Health (Fronzo, 2017). Strategies to prevent central line-associated bloodstream infections in acute care hospitals. The FDA requested that manufacturers of positive-displacement devices should conduct post-market surveillance to demonstrate that their devices were not associated with an increased risk of BSI compared to other types of device. 2019. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors. 
Central venous catheterization. However, it is well documented that compliance with this technique is low (Moureau and Flynn, 2015), creating a significant safety issue. NFCs are handled regularly when a catheter is in use, which is one reason why they need to be disinfected before use (Curran, 2016). 2011;52(9):e16293. 
The minimum CFU count on the controls (the needle-free connectors which were not decontaminated after inoculation with S. aureus) during the study was 5.17 log10 CFU for MicroClave and 5.49 log10 CFU for CareSite therefore total kill (TK) always represented a5.17 or5.49 log10 CFU reduction, respectively. Wallis MC, McGrail M, Webster J Risk factors for peripheral intravenous catheter failure. The manufacturer states that the BD PureHub cap maintains a physical barrier against contamination for up to 7 days if not removed, indicating that its use facilitates adherence to disinfection protocols. Sadly, non-compliance with the care and maintenance of VADs is often a catalyst for more serious complications, such as CRBSI. Studies, such as Curran (2016), have shown that colonisation of the NFC or the presence of intraluminal biofilm can result in pathogens finding a way into the internal lumen of the IV catheter and then into the bloodstream. However, if they are not maintained and used correctly, they can also increase the risk of intraluminal contamination (Hanchett, 2019). Curos: national IV port cleaning survey results. The BD PureHub is part of an approach to vascular access management that aims to improve efficiency, standardise practice and, ultimately, improve patient outcomes. BD PureHub is designed to ensure that the NFC is fully disinfected and acts as a barrier against the ingress of bacteria, protecting the NFC when the catheter is not in use. This work was presented in part as a poster at the 5th WorldCongress on Vascular Access, June 20-22 2018, Copenhagen, Denmark. Stevens TP, Schulman J. Evidence-based approach to preventing central line-associated bloodstream infection in the NICU. Following one activation of each connector, the external injection port of each sterile needle-free connector were inoculated with a 50L suspension containing at least 5106 CFU of S. aureus and allowed to air dry for 4h at 20C. It showed that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices. The caps act as passive disinfection devices which are designed to ensure that needle-free connectors are always clean. hbbd```b``f@$S%d'HM`&&k``0UeN /H2F@w9XL@]H?S U
Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. The level of significance was <0.05. 2014;40(12):12747. Frasca D, Dahyot-Fizelier C, Mimoz O. The aim of the study sample size was to demonstrate that each decontamination method achieved a 5 log10 reduction in the number of S. aureus (or 99.999% reduction). TSJE and ALC have received honoraria from BD for attendance at advisory board meetings and presentations at symposia. Reducing the degree of colonisation of venous access catheters by continuous passive disinfection. Clin Infect Dis. Google Scholar. The scrub-the-hub concept is not a new practice, and there is much evidence to support it. 172 0 obj
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The severity of an infection and its outcome will depend on many things including how quickly it is identified and treated, and the type of device used. It seems that the small crevices in the top of some NFCs can create dead space in which bacteria can multiply.
Care bundles have been shown to reduce infection rates (Choi et al, 2013) and the risk of complications associated with VADs (Sichieri et al, 2018). An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors. All authors read and approved the final manuscript. Furthermore, since there is concern surrounding potential chlorhexidine- and cross-resistance to antibiotics [15, 16], the use of a decontamination regime in the absence of chlorhexidine (such as the disinfection cap used in this study) may be appealing. Reducing bloodstream infection risk in central and peripheral intravenous lines: initial data on passive intravenous connector disinfection.
Fort Lauderdale; 2013. p. E64. Casey, A.L., Karpanen, T.J., Nightingale, P. et al. PubMed Use of the BD PureHub should reassure patients and healthcare organisations that catheters in situ are being protected. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. PN has no conflicts to declare. Springer Nature. In recent years, there have been many advances in techniques related to the insertion, care and maintenance of VADs, but there is still more to do. Loveday H, Wilson J, Pratt R epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Infect Control Hosp Epidemiol. There have been varying reports on the rates of bloodstream infection (BSI) associated with needle-free connectors including an increase in incidence following a change from split-septum connectors to mechanical connectors [1]. These include time savings [17], healthcare worker preference [17], a reduction in contamination of blood cultures [9], and cost savings [8, 9, 11]. In addition, care bundles also, of course, rely on compliance (Chopra and Shojania, 2013; McGuire, 2015; Simon et al, 2016). Manage cookies/Do not sell my data we use in the preference centre. 2016;94:21327. Moureau NL, Flynn J. Disinfection of needleless connector hubs: clinical evidence systematic review. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. British J Nursing.
2008;61:52432. Based on preliminary work, it was concluded that 54 of each type of needle-free connector in each scenario should give at least a 90% chance of achieving a 5 log10 reduction in CFU. 186 0 obj
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Several clinical studies have evaluated the use of these passive disinfection devices, all of which demonstrate benefits including significant reductions in the rates of hub microbial colonisation [7], and central-line associated bloodstream infections (CLABSI) [8,9,10,11,12]. Jarvis WR, Murphy C, Hall KK, et al. https://doi.org/10.1186/s13756-018-0342-0, DOI: https://doi.org/10.1186/s13756-018-0342-0. Evidence indicates they are effective, BD PureHub is a disinfecting cap that can be applied to the NFC of a vascular access device to protect against catheter-related bloodstream infection. Article Clin Infect Dis.
The authors concluded that passive disinfecting caps should be considered for inclusion in central-line maintenance care bundles.
02120366, https://doi.org/10.1016/j.bbmt.2018.12.595, https://doi.org/10.12968/bjon.2016.25.8.S25, https://doi.org/10.12968/bjon.2018.27.2.S18, https://doi.org/10.1136/bmjqs-2012-001480, https://doi.org/10.1016/j.java.2014.02.002, https://doi.org/10.12968/bjon.2017.26.19.S32, https://doi.org/10.1097/NAN.0b013e31825af099, https://doi.org/10.12968/bjon.2017.26.14.S4, https://doi.org/10.12968/bjon.2017.26.2.S14, https://doi.org/10.1016/S0195-6701(13)60012-2, https://doi.org/10.12968/bjon.2015.24.Sup8.S29, https://doi.org/10.1016/j.ajic.2014.09.008, https://doi.org/10.11124/JBISRIR-2017-003561, https://doi.org/10.1097/NAN.0000000000000075, https://doi.org/10.1016/j.ijnurstu.2017.01.00710.1016/j.ajic.2012.01.025, https://doi.org/10.1016/j.ijnurstu.2017.01.007, https://doi.org/10.1016/j.ajic.2012.05.030, Institute for Healthcare Improvement, 2019, Infusion Therapy Society (INS) standards, 2016, The distal hub of an intravenous catheter is the primary entry point for microbes into the lumen and thus the bloodstream. JBI Database Systematic Rev Implement Rep.. Copyright 2022 Mark Allen Group | Registered in England No. Alonso PB, Andersen H, Haslam D Scrubbing the hub, how long is enough?. Am J Infect Control. This would be the case in clinical areas where IV devices are frequently accessed such as in critical care. This can result in colonisation, which, if left untreated, can lead to systemic infection. Cameron-Watson concluded that passive disinfecting caps facilitate a consistent technique for the decontamination of NFCs, ensuring they are disinfected and dried (the kill time) for the correct time period. Wright et al (2013), DeVries et al (2014), Merrill et al (2014) and Stango et al (2014) all demonstrated similar results where passive disinfecting caps improved patient outcomes by reducing CRBSI rates and increasing adherence to catheter care and maintenance. ALC, TK were involved in the design, execution and analysis of the study and writing the associated manuscript. Kamboj M, Blair R, Bell N Use of disinfection cap to reduce central-line-associated bloodstream infection and blood culture contamination among hematology-oncology patients. (eds). BD has therefore developed a cap designed to enable rapid and powerful disinfection of NFCs. The risk of microbial contamination associated with six different needle-free connectors. 2014. We therefore considered that the comparison of the two decontamination regimes in this study to be representative of this latter clinical scenario. Current strategies for the prevention and management of central line-associated bloodstream infections. Chemical disinfectants and antiseptics quantitative test method for the evaluation of bactericidal and yeasticidal activity on non-porous surfaces with mechanical action employing wipes in the medical area (4- field test) Test method and requirements (phase 2, step 2). TSJE and TJK have received honoraria from 3M for attendance at advisory board meetings and presentations at symposia. Lee J. Disinfection cap makes critical difference in central line bundle for reducing CLABSIs. Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central-line associated bloodstream infections. Cite this article. The published evidence demonstrates that passive disinfecting caps can help reduce infection rates associated with different types of central venous catheters by protecting needlefree connectors from colonisation by pathogens and serving as a clear indicator that the line has been disinfected.
In 2015, Kamboj et al examined the impact of routine use of passive disinfecting caps on catheter hub decontamination in a group of haematology-oncology patients in a US centre. One way of mitigating this is to use passive disinfecting caps. Alonso et al (2019) also undertook a systematic review on disinfection times for NFCs, in which they identified that <15 seconds was substandard and that 30 seconds decreased the line contamination, suggesting that it should be incorporated into clinical practice. Alcoholic 2% chlorhexidine wipes. Centers for Disease Control and Prevention, Central line-associated bloodstream infection, Society for Healthcare Epidemiology of America. The care and maintenance of these devices is crucial in avoiding complications such as infection. Antimicrobial Resistance & Infection Control They found that use of the caps was associated with a 34% decrease in CLABSI rates in these high-risk patients. Recipes for checklists and bundles: one part active ingredient, two parts measurement. Voor In't Holt AF, Helder OK, Vos MC Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: a systematic review and meta-analysis. Taylor RW, Palagiri AV. The median and 95% CI log10 CFU reduction in S. aureus after decontamination for 15s with a 2% (w/v) CHG in 70% (v/v) IPA wipe followed by incubation at room temperature for 1, 3 or 7 days or after application of the disinfection cap for 1, 3 or 7 days is shown in Table1. Curos caps containing 70% (v/v) IPA (3M Healthcare) were compared to 2% (w/v) CHG in 70% (v/v) IPA wipes (Sani-cloth CHG 2%, PDI) for decontamination of the needle-free connectors. It could also be concluded that given the significant log10 CFU reductions observed with the 2% (w/v) CHG in 70% (v/v) IPA wipe in this study, there is no requirement for the additional efficacy of the disinfection cap. The evidence indicates that use of passive disinfecting caps is good practice for protecting lumens of central venous catheters. : Springer; 2018. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Log reduction is a mathematical term used to show the relative number of live microorganisms eliminated from a surface as a result of disinfection or cleansing. Unfortunately, care bundles alone will not achieve a reduction in CRBSI rates (Harnage, 2012) as the health professional needs to know what action to take when a complication is observed. Pronovost P, Needham D, Berenholtz S An intervention to decrease catheter-related bloodstream infections in the ICU. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Kelly LJ, Jones T, Kirkham S. Needle-free devices: keeping the system closed. 2014;35(7):75371. hWmo6+%kdh1lh#)Er HwG;Ry#P*Xa'{aED(Q)VsGDZy@(f.d\k\/,T]u1>*,WwY'Pt$U uuTM]\Uq>E#JGTnn.~=#}q0n/4P$?Oj>KXEE.>MY4nn2
DFy-d1m?Di,.frUWBez)gb=Vv#&x%,(o_vg=:]-fV&wus+[}e. PubMed The. A total of 54 of each type of needle-free connnector were studied (27 of each needle-free connector by each operator). Ramirez et al (2012) and Sweet et al (2012) both showed a significant reduction in CLABSI rates using disinfecting caps and an increase in adherence to care and maintenance bundles in a critical care setting and an oncology department, respectively. This offers an explanation for the lower rates of central-line associated bloodstream infection (CLABSI) associated with the use of disinfection caps reported in clinical studies. 2008;29(Suppl 1):S2230. Further research and evidence on the use of disinfecting caps on peripheral cannulae would be justified. The entire volume of neutralizing solution was inoculated (in addition to dilutions from positive control connectors) onto chromogenic S. aureus plates (ChromID S. aureus [Biomerieux]) in duplicate. 2012. An overnight culture of Staphylococcus aureus National Collection of Type Cultures (NCTC) 6538 on tryptic soy agar (Oxoid) was used to prepare a 1108CFU/mL suspension in tryptone sodium chloride (1g/L tryptone [Oxoid], 8.5g/L NaCl [Sigma-Aldrich] in distilled water) containing 3g/L bovine albumin faction V [VWR International] and 3ml/L defibrinated sheep blood [TCS Biosciences] in accordance with BS EN 16615:2015 [13]. Am J Infect Control. Nullification of antimicrobial activity and non-microbial toxicity was verified prior to commencement of the study (unpublished data). Nurs Res Pract 2015;2015:article 796762. %%EOF
BS EN 16615:2015. The care and maintenance of these VADs play a vital role in reducing the risk of CRBSIs. Percival SL, Williams DW, Randle J, Cooper T. Biofilms in Infection Prevention and Control. Provided by the Springer Nature SharedIt content-sharing initiative. Cameron-Watson (2016) examined the effect of implementing the use of a passive disinfecting cap on compliance and the incidence of VAD-related bacteraemia within one hospital trust. Indeed, the enhanced efficacy of the caps has also been reflected in decreased rates of CLABSI with increasing cap compliance [11, 15]. Brooks N. Intravenous cannula site management. All these advantages present a persuasive argument to utilise these devices in clinical practice. 2016.
Privacy Article In contrast, the term CLABSI is used for surveillance only. 2019. Cameron-Watson C. Port protectors in clinical practice: an audit. Nicols et al (2015) compared rates of colonisation inside the hub, assessed using cultures, and phlebitis in standard care (scrub-the-hub) versus a passive disinfection system that combined a luer disinfecting cap with a 70% isopropyl alcohol-impregnated sponge. To standardise clinical practice, it is essential to understand the definitions of CRBSI, which applies to all indwelling VADs, and central line-associated bloodstream infection (CLABSI). Menyhay SZ, Maki DG. Published evidence suggests that, among health professionals, adherence to best practice on the manual disinfection of NFC hubs is often poor, Passive disinfecting caps have been developed to address this problem, when used as part of a care bundle. English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: Preliminary data. A total of 54 of each needle-free connector were studied per time point following each decontamination procedure. J Assoc Vasc Access. Infect Control Hosp Epidemiol 2006;27(1):2327. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. However, the selected decontamination regimen used in this current study is representative of the outpatient scenario where central venous catheters may be accessed just once a week during clinic visits. (By reducing multiple needlesticks, ultrasound will not only increase vessel health but also reduce the number of breaches in the skin, and thus the risk of contamination and infection.). NFCs can also reduce the risk of other complications, such as occlusion, air embolism and thrombosis, and extend the life of the VAD (Kelly et al, 2017). Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Wright MO, Tropp J, Schora DM Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. : Elsevier; 2014. Woller et al (2016) stated that patients require IV therapy interventions earlier and for longer periods, and that long-term central venous access is now common in all areas of acute hospital and community settings. The needle-free connectors used in this study were a neutral displacement connector - MicroClave (ICU Medical) and a positive-displacement connector - CareSite (BBraun). We would like to thank Karen Burgess for her assistance in the laboratory. A potential limitation of this current study is that the selected single decontamination of the injection ports with a wipe may not be representative of the frequency with which this would occur in the clinical scenario. Of the nine UK and US studies included in the review, five described cost savings ranging from US$39 050 to US$3 268 990 (Voor et al, 2017). Hugill K. Preventing bloodstream infection in IV therapy. Anna L. Casey. Han Z, Liang S, Marschall J. Caps which attach to injection ports of needle-free connectors incorporating disinfectants have been developed. Central venous IV line infections are associated with increased physical and psychological morbidity, mortality, length of hospital stay and costs (Ferroni et al, 2014). An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors, Antimicrobial Resistance & Infection Control, https://doi.org/10.1186/s13756-018-0342-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. It is therefore conceivable that not only the improved antimicrobial activity of the caps versus wipes together with high levels of compliance with disinfection caps may both in part account for the lower rates of CLABSI associated with their use reported in previous clinical studies. In: Bogner MS. (ed). The cap has a distinctive colour, and so it can be easily identified that the attached hub has been disinfected. Another confounding factor is compliance to decontamination of needle-free connectors in clinical practice. The application of the disinfection cap resulted in a significantly higher log10 CFU reduction of the S. aureus than the 2% (w/v) CHG in 70% (v/v) IPA wipe, achieving a>5 log10 reduction in CFU at each time point. PubMed Central
2022 BioMed Central Ltd unless otherwise stated. Google Scholar. Decontamination of both types of needle-free device with a 2% (w/v) CHG in 70% (v/v) IPA wipe both following inoculation with S. aureus and following each subsequent incubation period resulted in a higher log10 CFU reduction as compared to only cleaning following contamination for MicroClave only (P=0.009). Disinfection relies on adherence to guidance on scrub-the-hub practice. Gutirrez Nicols F, Nazco Casariego GJ, Via Romero MM, Gonzalaz Garcia J, Ramos Diaz R, Perez Perez JA. 0
Nicols FG, Casariego GJ, Romero MM, Garca JG, Diaz RR, Perez JA. Indeed, no differences in log10 CFU reductions between these devices were observed. The aim of the study was to determine under controlled laboratory conditions whether a commercially available continuous passive disinfection cap which contains 70% (v/v) IPA was as effective for microbial decontamination of two different needle-free connectors when compared to defined standard cleaning with a 2% (w/v) CHG in 70% (v/v) IPA wipe. The evidence summarised above clearly indicates that the use of passive disinfecting caps on NFCs can significantly reduce CLABSI rates. Unfortunately, they were unable to come to a consensus, and this was ultimately defined by Holzmann-Pazgal (2019) as the presence of bacteraemia originating from an intravenous (IV) catheter. A systematic review and meta-analysis found that passive disinfecting caps significantly reduced the incidence of CLABSI when compared with manual disinfection.
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