Disinfection caps containing 70% (v/v) isopropyl alcohol (IPA) were attached to the connectors for one, three or 7 days and were compared with needle-free connectors cleaned with 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) IPA. (eds). We would like to thank Karen Burgess for her assistance in the laboratory. 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. The care and maintenance of these devices is crucial in avoiding complications such as infection. Hakko E, Guvenc S, Karaman I, Cakmak A, Erdem T, Cakmakci M. Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements. Manage cookies/Do not sell my data we use in the preference centre. Centers for Disease Control and Prevention, Central line-associated bloodstream infection, Society for Healthcare Epidemiology of America. Indeed, the enhanced efficacy of the caps has also been reflected in decreased rates of CLABSI with increasing cap compliance [11, 15]. Sweet MA, Cumpston A, Briggs F, Craig M, Hamadani 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. 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. Brooks N. Intravenous cannula site management. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. The device, called the BD PureHub uses a sterilised 70% isopropyl alcohol solution to disinfect NFCs, providing a >4-log (99.99%) reduction in bacteria within 1 minute of application (BD White Paper, 2018). Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. 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. This reduction equated to an estimated annual saving of US$3.2 million.

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. Am J Infect Control. curos chlorhexidine This work was presented in part as a poster at the 5th WorldCongress on Vascular Access, June 20-22 2018, Copenhagen, Denmark. Bundles. They found that use of the caps was associated with a 34% decrease in CLABSI rates in these high-risk patients. However, in line with the above findings, the disinfection cap still resulted in a significantly higher log10 CFU reduction (Table1) as compared to the two decontaminations with 2% (w/v) CHG in 70% IPA (v/v) wipes for both needle-free connectors (MicroClave P=0.041, CareSite P<0.0001, median [95% CI]=TK [TK-TK] for both types of connector). Antimicrob Resist Infect Control 7, 50 (2018). One way of mitigating this is to use passive disinfecting caps.

3m curos protectors ensure ports disinfecting protect peace port mind 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. Menyhay and Maki described such a device containing 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol (IPA) in 2006 [6]. 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. Following contamination with S. aureus, 54 of each type of needle-free connector were cleaned as above for 15s with a 2% (w/v) CHG in 70% (v/v) IPA wipe and allowed to dry for 30s. These were then incubated for 7 days at 20C and then cleaned again with a 2% (w/v) CHG in 70% (v/v) IPA wipe prior to microbiological sampling. In contrast, intraluminal CRBSI remains the most significant infection complication but, unlike extraluminal infections, it might not be visible. In contrast, the term CLABSI is used for surveillance only. curos caps 3m disinfecting cap port alcohol impregnated needless protector connectors needleless protectors 2014;35(7):75371. https://doi.org/10.1186/s13756-018-0342-0, DOI: https://doi.org/10.1186/s13756-018-0342-0. If NFCs have been insufficiently cleaned or are touched after disinfection, there is a risk that bacteria could be injected into the vascular system when they are next used (Percival et al, 2014). 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]. 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. Indeed, no differences in log10 CFU reductions between these devices were observed. Antimicrobial Resistance & Infection Control Hadaway L. Short peripheral intravenous catheters and infections. No differences in the degree of contamination were found between NFCs used on central venous and peripheral VADs and there were no cases of phlebitis. PubMedGoogle Scholar. 2016;94:21327. Jarvis WR, Murphy C, Hall KK, et al. Infusion therapy standards of practice. CAS This safety risk was highlighted in a study by Casey et al (2018), which investigated the differences in microbial ingress between six different NFCs. Like Madni and Eastman (2018), the experts attend the round table were trying to devise an umbrella term to cover both classifications. Adherence to recommended decontamination procedures by healthcare workers prior to access of needle-free connectors has been reported to be as low as 10% [14], whereas with the use of caps compliance has been high [8,9,10]. Terms and Conditions, Curran E. Needleless connectors: the vascular access catheter's microbial gatekeeper. JBI Database Systematic Rev Implement Rep.. Copyright 2022 Mark Allen Group | Registered in England No. 2011;52(9):e16293. J Infus Nurs. Reducing the degree of colonisation of venous access catheters by continuous passive disinfection. Taylor RW, Palagiri AV. 2016;23:1313. It explores how these complications occur and outlines the evidence on how to avoid them. Disinfection of needleless connector hubs: clinical evidence systematic review. Needleless connectors and bacteraemia: is there a relationship?. Strategies to prevent central lineassociated bloodstream infections in acute care hospitals: 2014 update. However, if compliance with the use of wipes is low, the disinfection caps could prove a useful tool. Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. The level of significance was <0.05. 2016. 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). Health Protection Agency. The scrub-the-hub concept is not a new practice, and there is much evidence to support it. 2012;17(4):2103.

curos disinfecting cff1 270r connettori needleless connectors connectoren 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). : Springer; 2018. Chopra V, Shojania KG. A systematic review found that colonisation of NFC hubs is considered to cause 50% of post-insertion catheter-related infections (Moureau and Flynn, 2015). PN has no conflicts to declare. Sweet MA, Cumpston A, Briggs F, Craig M, Hamadani 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. They act as a physical barrier between line accesses. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. BS EN 16615:2015.

Nullification of antimicrobial activity and non-microbial toxicity was verified prior to commencement of the study (unpublished data). 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. Before the audit, staff at the trust had scrubbed the hub with a wipe impregnated with 2% chlorhexidine and 70% alcohol. The cap serves as a barrier to intraluminal infection and its bright colour provides a visual prompt to health professionals to undertake VAD care and maintenance. An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors. 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. 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). Caps which attach to injection ports of needle-free connectors incorporating disinfectants have been developed. This article focuses on the risk of complications associated with the improper care and maintenance of needlefree connectors (NFCs) and IV lines. Eur J Hosp Pharm. 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). The actual cap has finger grips to ease application and removal (Figure 1). The manual disinfection of NFC requires a multi-step approach, but the technique and length of time required for manual disinfection are open to interpretation. 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. Stango C, Runyan D, Stern J, Macri I, Vacca M. A successful approach to reducing bloodstream infections based on a disinfection device for intravenous needleless connector hubs. Gutirrez Nicols F, Nazco Casariego GJ, Via Romero MM, Gonzalaz Garcia J, Ramos Diaz R, Perez Perez JA. Clin Infect Dis. By using this website, you agree to our 2012. Simon A, Furtwngler R, Graf N Surveillance of bloodstream infections in pediatric cancer centers: what have we learned and how do we move on?. In 2016, Pronovost et al published research on the progress of the first version of the Michigan Keystone project research data, which had been initiated in 2009. There is a significant risk that microorganisms can enter the exit site, form a biofilm on the outside of the indwelling catheter and then find their way into the bloodstream (Taylor and Palagiri, 2007; Han et al, 2010). Similarly, if the disinfection caps were employed in the inpatient clinical scenario they would be accessed and replaced more frequently. Its use will help protect patients and reduce costs. The evidence indicates that use of passive disinfecting caps is good practice for protecting lumens of central venous catheters. 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. PubMed Central

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. Kampf G. Acquired resistance to chlorhexidine is it time to establish an antiseptic stewardship initiative? Fort Lauderdale; 2013. p. E64. 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. : Elsevier; 2014. TSJE and TJK have received honoraria from 3M for attendance at advisory board meetings and presentations at symposia. 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). DeVries M, Mancos PS, Valentine MJ. 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. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Frasca et al (2010) and, more recently, Moreau et al (2019) stated that the most effective way to reduce the risk of exit site infection is to regularly decontaminate the skin surrounding the catheter exit site and then cover the device with a semipermeable, vapour permeable dressing, ensuring that the area of decontaminated skin is larger than the film dressing. Percival SL, Williams DW, Randle J, Cooper T. Biofilms in Infection Prevention and Control. s7*~ tk0a`Y v;nXBT1z ;Y'D PubMed This can be important for patients with a tunnelled renal catheter, which should only be used for dialysis. : CRC Press; 1994. 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. This was the case for both types of needle-free connectors tested during this study, demonstrating the efficacy across more than one specific device. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. A 4-log reduction means the number of germs is 10 000 times smaller than it was previously. In: Bogner MS. (ed). The results demonstrated a significant reduction in central venous catheter-related infection following implementation of simple infection-control practices such as standardised skin decontamination before catheter insertion; use of sterile drapes, gowns and gloves; and use of ultrasound to cannulate the vessel. Article 186 0 obj <>stream Recipes for checklists and bundles: one part active ingredient, two parts measurement. Choi SW, Chang L, Hanauer DA Rapid reduction of central line infections in hospitalized paediatric oncology patients through simple quality improvement methods. Cite this article. Reducing bloodstream infection risk in central and peripheral intravenous lines: initial data on passive intravenous connector disinfection. BD PureHub Disinfecting Cap Design Verification and Sterilization Validation. Madni T, Eastman AL. 0 This website is intended for healthcare professionals, Advanced Nurse Practitioner, Vascular Access and IV Therapy Lead, Frimley Health NHS Foundation Trust, View Cameron-Watson C. Port protectors in clinical practice: an audit. 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). Needle-free connectors were cleaned for 15s (through 180 15 times) with a 2% (w/v) CHG in 70% (v/v) IPA wipe and allowed to dry for 30s (this method was completed independently by two different experienced operators). In addition, care bundles also, of course, rely on compliance (Chopra and Shojania, 2013; McGuire, 2015; Simon et al, 2016). Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Its implementation into practice requires training and education to ensure correct use and continued adherence to the new practice. 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. J Hosp Infect. Article Prevention of central venous catheter-related infection in the intensive care unit. 149 0 obj <> endobj 2015.

Alonso PB, Andersen H, Haslam D Scrubbing the hub, how long is enough?. Sichieri K, Iida LIS, Garcia PC Central line bundle maintenance among adults in a university hospital intensive care unit in So Paulo, Brazil: a best practice implementation project. 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. Whilst the high inoculum of S.aureus used in this study would not be expected in the clinical scenario, it permitted the identification of any differences present between the two decontamination methods, was also representative of European standard antiseptic test conditions [13], and simulated a worst-case scenario in the clinical situation. Nicols FG, Casariego GJ, Romero MM, Garca JG, Diaz RR, Perez JA. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Central venous IV line infections are associated with increased physical and psychological morbidity, mortality, length of hospital stay and costs (Ferroni et al, 2014). English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: Preliminary data. 2008;61:52432. 2019. The application of the disinfection cap resulted in a significantly higher reduction in 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. Holzmann-Pazgal G. Central line-associated bloodstream infection (CLABSI). 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.



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