Sweet, M.A., Cumpston, A., Briggs, F., Craig, M., & Hamadani, M. (2012). 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. American Journal of Infection Control, 40, 931–934.
The objective of this study was to assess the effect of optimizing hub disinfection using alcohol-impregnated port protectors by measuring the rate of central line-associated bloodstream infections (CLABSIs) and contaminated blood cultures (CBCs) in adult oncologic patient population.
The intervention involved switching traditional catheter hub care using alcohol wipes to care using 70% isopropyl alcohol-impregnated port protectors and needless neutral-pressure connectors. The intervention period results were compared to those from historical controls. Data were collected for all types of central lines, including peripherally inserted tunneled catheters and implanted ports. Line insertion techniques followed best practices for draping, skin prep, etc. Port protectors are luer lock-style caps with provide cleaning as they are twisted on and off catheter hubs. A new protector is used each time the port is accessed. Compliance was assessed by weekly observations defined as percentage of patients with catheter protectors in place.
A single-site inpatient setting in West Virginia
Active antitumor treatment
Observational trial with comparison to historical controls
Observational comparison. Researchers compared CLABSI and CBC rates before and after intervention.
There was a statistically significant decrease in CLABSI rates with the use of alcohol-impregnated port protectors from 2.3 per 1,000 central line days to 0.3 per 1,000 central line days during the intervention period (RR = 0.14, 95% CI [0.02, 1.07], p = 0.03). The rate of contaminated blood cultures decreased from 2.5% to 0.2% (RR = 0.09, 95% CI [0.01, 0.65], p = 0.002).
The use of alcohol-impregnated port protectors may help to reduce CLABSI rates. Further evidence is needed to make strong conclusions.
Suboptimal hub disinfection has a great effect on CLABSI rates. The use of alcohol-impregnated port protectors could help prevent CLABSI by eliminating this factor from the equation; however, effect sizes shown here are small. There are numerous limits to the evidence provided here which reduces the strength of the evidence and any conclusions that can be drawn; however, findings are promising. Additional well-designed studies are warranted. It would be useful to have associated cost benefit analysis, and studies comparing this approach to others to determine most cost-effective approaches to reduce CLABSI risk and rates.