Brown. Disinfection of the exposed surface of the NC is necessary to avoid contamination and subsequent intraluminal biofilm formation and protect patients from infection. Split septum access devices continue to be recommended as a lower risk option for needleless connection; however, they have lost popularity because they require multiple parts and pieces for access and allow direct needle access through the septum/diaphragm leading many facilities to switch to luer access devices. During the period of needle usage for catheter access, nurses and doctors intuitively knew the necessity of disinfecting the access septum prior to inserting a needle. When the cleansing cap was used on stopcocks Holroyd found contamination and increased CFU. Copyright 2015 Nancy L. Moureau and Julie Flynn. Consistent application of the bundle, with compliance verified during the insertion procedure (checklist), has reduced insertion related CLABSI by more than 44% in the USA [52]. An in vivo hospital study by DeVries gave nurses a choice to use either this single use cleansing cap or a disinfection cap to leave on the NC access site, clinicians preferred the longer lasting disinfection cap [14]. In actual practice disinfection prior to access is expected, while cleansing after each access is rarely done. More studies are needed to provide efficacy for optimal time necessary to eliminate surface contaminants. studies of adult, pediatric, or neonatal increasingly important role patients not inclusive of intravascular device disinfection practices. Poster and abstract presentations on disinfecting caps/port protectors. Research performed at one institution revealed that patient skin flora was not the source of catheter related bloodstream infections in any of their cases; all infections in this study originated from the catheter hub [6, 113]. (7) C. C. Chernecky, D. Macklin, W. R. Jarvis, and T. V. Joshua. Disinfection of a catheter hub prior to flushing or prior to the administration of medications is required for all aseptic access, yet in the Karchmer study, 31% of clinicians did not even attempt to disinfect, even when under active observation [1, 64, 88, 114]. NC have gaps of differing widths between the septal seal and the housing which may allow ingress of microorganisms [7, 23, 99, 143]. (30) D. Warren, J. Zack, and J. Mayfield. Passive disinfection caps reduce guess work, provide clinicians with a point of use solution, and reduce contamination. According to the Epic3 Evidence-Based Guidelines for Preventing Healthcare Infections, disinfection is defined as the use of chemical or physical methods to reduce the number of pathogenic microorganisms on surfaces to a level at which they are not able to cause harm, but which does not usually destroy spores [53]. Part 2,, L. Hadaway, Intermittent intravenous administration sets: survey of current practices,, B. M. Farr, Reasons for noncompliance with infection control guidelines,, D. Platace, I. Klava, L. Antonevica et al., The study of the risk factors of health careassociated infections in patients' care with invasive devices,, J. S. Smith, K. M. Kirksey, H. Becker, and A. A catheter is inserted into a vein or artery to provide a pathway for the administration of medications or solutions necessary to improve a patients health or condition. JCM MED223 Chemin de Bellevue,
The goal of this review is to assess current literature related to disinfection of NC to establish recommendations that promote aseptic access, reducing infection risk for the patient. Exclusion criteria were(i)nonresearch papers,(ii)studies of adult, pediatric, or neonatal increasingly important role patients not inclusive of intravascular device disinfection practices,(iii)primary populations outside acute care,(iv)publications not translated into English,(v)studies prior to 1984. (36) A. Sitges-Serra, P. Puig, J. Linares et al.. (37) B. W. Trautner and R. O. Darouiche. Access catheter connections with sterile devices only [, Antimicrobial caps/port protectors may be effectively used for passive continuous hub disinfection on needleless connections in accordance with manufacturer instructions, in conjunction with frictional antiseptic wiping between applications and access [, Ensure compliance with hand hygiene, gloving and aseptic practices prior to any contact with intravenous devices and add-on equipment [, Establish and educate all clinical staff on a standard protocol to disinfect catheter hubs, needleless connectors and ports prior to and after each access [, Provide consistent and varied staff education on consequences of poor technique along with clinical reminders of best practice [, Establish regular surveillance of compliance for disinfection of intravascular devices prior to access with reporting of results to each care unit [, Establish a formal process to evaluate new technology and needleless connector designs [, Implement a multimodal quality improvement infection prevention program that applies guidelines and recommendations to all intravascular practices [, L. Hadaway, Needleless connectors: Improving practice, reducing risks,, I. F. Btaiche, D. S. Kovacevich, N. Khalidi, and L. F. Papke, The effects of needleless connectors on catheter-related bloodstream infections,, W. R. Jarvis, C. Murphy, K. K. Hall et al., Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors,, E. Bouza, P. Muoz, J. Lpez-Rodrguez et al., A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study,, C. Chernecky and J. Waller, Comparative evaluation of five needleless intravenous connectors,, A. Sitges-Serra, Strategies for prevention of catheter-related bloodstream infections,, W. Jarvis, Choosing the best design for intravenous needleless connectors to prevent healthcare-associated bloodstream infections,, N. P. O'Grady, M. Alexander, L. A. Burns et al., Guidelines for the prevention of intravascular catheter-related infections,, V. Chopra, S. Krein, R. Olmstead, N. Safdar, and S. Saint, Prevention of central line-associated bloodstream infections: brief update review, in, J. M. D. Marschall, L. A. D. O. S. Mermel, M. M. D. M. P. H. Fakih et al., Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update,, INS, Infusion nursing standards of practice,, S. Z. Menyhay and D. G. Maki, Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap,, S. Simmons, C. Bryson, and S. Porter, Scrub the hub: cleaning duration and reduction in bacterial load on central venous catheters,, M. DeVries, P. S. Mancos, and M. J. Valentine, Reducing bloodstream infection risk in central and peripheral intravenous lines: Initial data on passive intravenous connector disinfection,, M. B. Salzman and L. G. Rubin, Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections,, D. P. Halpin, P. O'Byrne, G. McEntee, T. P. J. Hennessy, and R. B. Stephens, Effect of a Betadine connection shield on central venous catheter sepsis,, A. T. Stotter, H. Ward, A. H. Waterfield, J. Hilton, and A. J. Sim, Junctional care: the key to prevention of catheter sepsis in intravenous feeding,, M. Pittiruti, Port protectors and educational intervention: the key to zero central line-associated bloodstream infectiona randomized controlled trial, in, S. Z. Menyhay and D. G. Maki, Preventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors,, N. Moureau and R. Dawson, Passive disinfection product effectiveness study, in, M. B. Salzman, H. D. Isenberg, and L. G. Rubin, Use of disinfectants to reduce microbial contamination of hubs of vascular catheters,, M. B. Salzman, H. D. Isenberg, J. F. Shapiro, P. J. Lipsitz, and L. G. Rubin, A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates,, M. Ryder, Access site and hub disinfection: in vitro testing of a novel device, in, A. L. Casey, S. Burnell, H. Whinn, T. Worthington, M. H. Faroqui, and T. S. J. Elliott, A prospective clinical trial to evaluate the microbial barrier of a needleless connector,, J. P. Kennedy, R. A. Lasher, D. Solomon, and R. W. Hitchcock, Disinfection of male luer style connectors for prevention of catheter related bloodstream infections using an isopropyl alcohol dispensing cap,, M.-O. As demonstrated by multiple studies, infections are drastically lower or eliminated by disinfecting or covering the access hub with an antimicrobial cap [14, 1620, 113, 127, 144146]. The results of the Pennsylvania Patient Safety Advisory Report and independent biofilm sampling of NC suggest that more attention is needed for aseptic access and maintenance practices [109]. Stango and associates reported a 50% reduction in CLABSIs and a savings of $464,440 per year after alcoholic cap implementation [184]. (2) I. F. Btaiche, D. S. Kovacevich et al., (4) C. Chernecky, Biofilm formation in connectors characterized by using electron microscopy,, (6) J. Davis, Pennsylvania patient safety authority 2011,. M. Khalil, J. W. Costerton, C. Lam, and G. P. Bodey, The relationship between the thrombotic and infectious complications of central venous catheters,, J. Davis, Central-line-associated bloodstream infection: comprehensive, data-driven prevention,, L. A. Mermel, What is the predominant source of intravascular catheter infections?, C. Chernecky, Biofilm formation in connectors characterized by using electron microscopy, in, M. A. Ryder, Catheter-related infections: it's all about biofilm,, A. Sitges-Serra, P. Puig, J. Linares et al., Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition,, T. Karchmer, E. Cook, E. Palavecino, C. Ohl, and R. Sherertz, Needleless valve ports may be associated with a high rate of catheter-related bloodstream infection [poster 307], in, J. Lee, Disinfection cap makes critical difference in central line bundle for reducing CLABSIs, in, L. Hadaway, Short peripheral intravenous catheters and infections,, B. S. Nil-Weise, T. J. Daha, and P. J. van den Broek, Is there evidence for recommending needleless closed catheter access systems in guidelines? catheter cap, access port, disinfecting cap, antimicrobial cap, hub protection cap, and port protector. Measurement of compliance with hub disinfection is challenging, requiring direct observation of the action unless disinfection caps/ports are used on all NC hubs as a form of verification. Its design and operation improves work efficiency by saving time, gestures, swabbing devices and increased safety. Studies show there is a need for clear recommendations and practices that prevent transmission of contaminants through NC [68, 90]. Sweet, A. Cumpston, F. Briggs, M. Craig, and M. Hamadani. Risk factors for infection include poor adherence to aseptic technique, needleless connector (NC) design variations, and inconsistent health care staff education and training [13]. Disinfection of the NC access site was not included in the insertion related central line bundle. NC are used on virtually all intravascular devices in the USA; they provide an easy access point for syringe or tubing attachment and have now become the central access point for all connections. (17) B. S. Nil-Weise, T. J. Daha, P. J. van den Broek. These guidelines further state that disinfection methods used in combination with cleaning blood or other debris off the surface as disinfectants have limited ability to penetrate organic material [8]. A systematic review of randomized controlled trials,, V. D. Rosenthal and D. G. Maki, Prospective study of the impact of open and closed infusion systems on rates of central venous catheter-associated bacteremia,, M. Ishizuka, H. Nagata, K. Takagi, and K. Kubota, Needleless closed system does not reduce central venous catheter-related bloodstream infection: a retrospective study,, K. Field, C. McFarlane, A. C. Cheng et al., Incidence of catheter-related bloodstream infection among patients with a needleless, mechanical valve-based intravenous connector in an Australian hematology-oncology unit,, N. Safdar and D. G. Maki, The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters,, L. C. Hadaway, Skin Flora and Infection,, D. G. Maki, C. E. Weise, and H. W. Sarafin, A semiquantitative culture method for identifying intravenous catheter related infection,, D. G. Maki, S. M. Stolz, S. Wheeler, and L. A. Mermel, Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial,, A. Sitges-Serra, J. Linares, and J. Garau, Catheter sepsis: the clue is the hub,, M. L. Moro, E. F. Vigan, and A. C. Lepri, Risk factors for central venous catheter-related infections in surgical and intensive care units. Linares and colleagues reported 14 episodes of sepsis (70% of total catheter related septic events) resulted from hub-related contamination [127, 133]. More and more studies reveal lack of compliance with disinfection of access ports prior to and after access, despite educational initiatives, and better disinfection agents [1, 26, 27, 38, 54, 57, 64, 67, 69, 72, 74, 78, 83, 8893, 188, 198205]. Maximum sterile barriers also reduce contamination during the insertion process so that overall, CLABSI rates occurring in the first few days of insertion continue to fall. (35) W. Zingg, A. Imhof, M. Maggiorini et al., Recommendations for disinfecting practices, Use disinfection on surfaces of needleless connectors, stopcocks and other intravascular access ports immediately prior to any connection, infusion or aspiration with appropriate antiseptic agent (e.g., alcoholic chlorhexidine, povidone iodine, an iodophor, or 70% alcohol). This systematic review highlights the lack of available high quality research in this area that tests the cause and effect relationship between NC disinfection practices and patient infection outcomes. Preventing this form of contamination requires teaching and constant reinforcement of the required practice of regular and consistent disinfection prior to every access. guidelines and recommendations for infection prevention with disinfection. In early studies by Sitges-Serra colonization of the catheter hub was considered the primary pathogenesis of catheter associated infection [15, 113]. Rather than creating devices such as the ultraviolet C port to eradicate contamination within the hub, the goal should be to eliminate surface pathogens before entering the NC or catheter. This study found 70% alcohol wipes and this alcohol cleansing cap were both effective on the surface of NC and catheter hubs [151]. (12) H. Hong, D. F. Morrow, T. J. Sandora, and G. P. Priebe. Disinfection Caps for Needle-free Connectors, DISINFECTION CAPS FOR NEEDLE-FREE CONNECTORS. Sources of contamination literature. Research and study are necessary as an integral part of professional practice, providing a means to direct clinical activity and to share with rising young clinicians long after we are gone. Adequate cleaning or need for additional cleaning of the septal access site may be based on the specific design features of the individual NC [2, 4, 5, 7, 70, 111, 129, 153, 159161]. The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 560 seconds is recommended. While many experts agree that application of the insertion bundle is one of the best ways to prevent insertion-related infection, the bundle does not address NC, aseptic access, or any postinsertion catheter usage issues. Inclusion criteria consisted of publications meeting search terms and topic requirements under sub groupings:(1)disinfection agents used on intravascular device surfaces including studies and reviews of NC and infection prevention,(2)sources of contamination through intravascular devices,(3)education and compliance for infection prevention,(4)guidelines and recommendations for infection prevention with disinfection. A BEME systematic review: BEME Guide No. BEME Guide No. (24) D. Platace, I. Klava, L. Antonevica et al.. (25) P. Pronovost, D. Needham, S. Berenholtz et al.. (28) J. Segreti, S. Garcia-Houchins, L. Gorski et al.. (29) J. S. Smith, K. M. Kirksey, H. Becker, A. Achieving zero CoN CLBSI in the NICU,, (16) J. Lee, Disinfection cap makes critical difference in central line bundle for reducing CLABSIs,, (17) B. Lopansri, I. Nicolescu, J. Parada, A. Tomich, J. Belmares, and P. Schereckenberger, Microbial colonization of needleless intravenous connectors and the male luer end of IV administration sets: does the partner matter?, (18) D. Maslak, D. Rossettini, L. Trento, and M. Leone, Catheter maintenance in the home parenteral nutrition patient = reduced CRBSIs,, (19) S. McCalla, J. Greco, M. Warren, P. Byrne, and J. Bogetti, Integrated delivery system of disinfection cap and flush syringe, plus staff education, reduce bloodstream infections and treatment costs,, (20) M. Moore, K. Gripp, H. Cooper, and R. Almeida, Providence Sacred Heart Medical Center: impact of port protectors on incidence of central line infections,.
Sitemap 30