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This work was presented in part as a poster at the 5th WorldCongress on Vascular Access, June 20-22 2018, Copenhagen, Denmark.

Sadly, non-compliance with the care and maintenance of VADs is often a catalyst for more serious complications, such as CRBSI. : CRC Press; 1994. In catheters being used to administer parenteral nutrition, the cap can be used to protect the NFC and lumen of catheters from transient bacteria; these can colonise and rapidly multiply in areas around the connector, where the parenteral nutrition liquid can lay dormant when the catheter is not in use (RCN, 2016). Royal College of Nursing. Kampf G. Acquired resistance to chlorhexidine is it time to establish an antiseptic stewardship initiative? However, manual disinfection of NFCs is significantly affected by human factors such as workload, stress, competency and training (Van Cott, 1994). Lee J. Disinfection cap makes critical difference in central line bundle for reducing CLABSIs. 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). The injection ports of needle-free connectors were inoculated with Staphylococcus aureus and allowed to dry. However, it seems that the amount of time required to disinfect a NFC is often overlooked by health professionals. Many devices and systems are currently available, with more innovations expected. TSJE and TJK have received honoraria from 3M for attendance at advisory board meetings and presentations at symposia. This can be important for patients with a tunnelled renal catheter, which should only be used for dialysis. Casey AL, Karpanen TJ, Nightingale P, Elliott TS. The caps act as passive disinfection devices which are designed to ensure that needle-free connectors are always clean. In contrast, the term CLABSI is used for surveillance only. During the 6-month audit period, when the trust switched to the passive disinfecting cap, CRBSI rates reduced from 26 to eight cases (69%); staff compliance with the disinfection procedure increased to 80%.

PubMed The level of significance was <0.05. NFCs can protect against contamination and infection of the distal hub of the IV catheter, which is a primary entry point for microorganisms into the catheter lumen and the bloodstream. There was no significant difference between the two operators in terms of log10 CFU reduction of S. aureus following 15s decontamination with a 2% (w/v) CHG in 70% (v/v) IPA wipe and drying for 30s for both the MicroClave (4.69, 95% CI=3.565.29 vs 4.61, 95% CI=3.995.21, P=0.73) and CareSite (5.10, 95% CI=4.11-TK vs 5.10, 95% CI=3.04-TK, P=0.32). 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. Jarvis WR, Murphy C, Hall KK, et al. 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. 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. Cookies policy.

: Elsevier; 2014. The bijous were then sonicated for 10min at 50Hz. PubMed 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. 2015. 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 dressing should be left in place for 7 days, during which time it should not be disturbed unless debris is visible under the dressing or the dressing starts to lift (Royal College of Nursing (RCN), 2016). 2019. Percival SL, Williams DW, Randle J, Cooper T. Biofilms in Infection Prevention and Control. 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. 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. 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.

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). J Assoc Vasc Access. Assessments included how long it took to manually disinfect them (including drying time). Google Scholar. CAS Am J Infect Control. Strategies to prevent central lineassociated bloodstream infections in acute care hospitals: 2014 update. The actual cap has finger grips to ease application and removal (Figure 1). However, if compliance with the use of wipes is low, the disinfection caps could prove a useful tool. Terms and Conditions, Nullification of antimicrobial activity and non-microbial toxicity was verified prior to commencement of the study (unpublished data). Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central-line associated bloodstream infections. Caps which attach to injection ports of needle-free connectors incorporating disinfectants have been developed. The Centers for Disease Control and prevention (CDC) has subsequently recommended that when needleless systems are used, a split-septum valve may be preferred over some mechanical valves [2]. Han Z, Liang S, Marschall J. BD has therefore developed a cap designed to enable rapid and powerful disinfection of NFCs. The care and maintenance of these VADs play a vital role in reducing the risk of CRBSIs. Clinell. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Since then, healthcare providers have understood that the process for reducing vascular access device (VAD)-related infection is multidimensional, and that, with the right interventions, a near zero CRBSI rate is possible (Hakko et al, 2015). Curran E. Needleless connectors: the vascular access catheter's microbial gatekeeper. These include time savings [17], healthcare worker preference [17], a reduction in contamination of blood cultures [9], and cost savings [8, 9, 11]. 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). Part of 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. : Springer; 2019. Frequency of biocide resistance genes, antibiotic resistance and the effect of chlorhexidine exposure on clinical methicillin-resistant Staphylococcus aureus isolates. Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. The cap has a distinctive colour, and so it can be easily identified that the attached hub has been disinfected. Eur J Hosp Pharm. PubMedGoogle Scholar. Cameron-Watson C. Port protectors in clinical practice: an audit.

Advances in treatment often entail extended indwell times for central vascular access devices. Knowledge about how CRBSI and exit site infections occur can help avoid their occurrence; understanding the differences between intraluminal and extraluminal infection can inform healthcare providers about which measures will maintain the catheter (Kallen et al, 2010) and keep it free from complications. 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. 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. The BD PureHub should be changed when this flushing takes place. Despite these advances, the risk of complications persists, so the priority remains to focus on the basics. 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]. In: Proceedings of the APIC annual conference, vol 39. In their systematic review, Moureau and Flynn (2015) concluded that, despite educational initiatives and the availability of more effective disinfection agents, there is still non-adherence to best practice for disinfecting access ports, both before and after access. Google Scholar. Am J Infect Control. 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. The risk of microbial contamination associated with six different needle-free connectors. JBI Database Systematic Rev Implement Rep.. Copyright 2022 Mark Allen Group | Registered in England No. The results of this study support the SHEA/IDSA practice special approach recommendation for preventing CLABSI to use an antiseptic-containing hub/connector cap/port protector to cover connectors (quality of evidence: I) [4]. It showed that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices. All the needle-free connectors were subsequently left at 20C in air for 1, 3 or 7 days. 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. 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). 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]. All VADs with out-of-the-body dwelling lumens, such as peripherally inserted central catheters (PICCs) and tunnelled catheters, should be flushed every 7 days if not removed, regardless of whether or not they are in use (RCN, 2016). Privacy 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. Gutirrez Nicols F, Nazco Casariego GJ, Via Romero MM, Gonzalaz Garcia J, Ramos Diaz R, Perez Perez JA. Choi SW, Chang L, Hanauer DA Rapid reduction of central line infections in hospitalized paediatric oncology patients through simple quality improvement methods. Care bundles provide a structured framework for delivering evidence-based care: they generally comprise a set of three to five clinical practices, some of which may relate to the use of devices, that when performed collectively and reliably, have been proven to improve patient outcomes (Institute for Healthcare Improvement, 2019). 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]. 2012.

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