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07/18/2017

Introduction

The project will analyze how does the use of antiseptic barrier caps compare with the use of manual alcohol swabs in the prevention of central line infections in adult hospitalized students.

Overview of the Problem

The microorganisms aim to access a central venous catheter through the catheter hub which should be appropriately disinfected in order to prevent central line-associated bloodstream infections (CLABSIs). But, compliance with the manual disinfection process is very time-consuming. Therefore, antiseptic barrier cap is used as an alternative to this problem to prevent central line infections.

Project purpose statement

Spotlight on the use of antiseptic barrier caps as compared with the use of manual alcohol swabs in the prevention of central line infections in adult hospitalized students.

Background and significance

“Reducing to zero” the rate of central-line–associated bloodstream infections (CLABSIs) are needed optimizing to catheter insertion as well as to maintaining the catheters. One currently invented approach to decrease CLABSI rates is the use of catheter-port antiseptic barrier caps which contain an antiseptic-impregnated sponge to disinfect the port hub during placement and thereafter physically covers the hub. The investigators have conducted a multiphase prospective trial in order to assess the efficacy of antiseptic barrier caps in reducing rates of CLABSIs and blood culture contamination in a single tertiary-care cancer center. Therefore, the use of an antiseptic barrier caps for intravenous catheter ports aims to reduce rates of central-line–associated bloodstream infections in a high-risk cancer unit.

Literature Review

According to the current study, the catheter hub should be appropriately disinfected to prevent central line-associated bloodstream infections (CLABSIs) (Blood diseases and conditions – sepsis, 2017). The news reporters obtained a quote from the research from Sophia Children’s University Hospital, “However, compliance with the time-consuming manual disinfection process is low. An alternative is the use of an antiseptic barrier cap, which cleans the catheter hub by continuous passive disinfection. To compare the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs. Systematic review and meta-analysis.

The primary outcome, reduction in CLABSIs per 1000 catheter-days, expressed as an incidence rate ratio (IRR) was analysed with a random effects meta-analysis. The studies were included if that are conducted in a hospital setting or used antiseptic barrier caps on hubs of central lines with access to the bloodstream and reported the number of CLABSIs per 1000 catheter-days when using the barrier cap and when using manual disinfection.

According to the study (Blood diseases and conditions – sepsis, 2017), a total of 1537 articles were identified as potentially relevant and after exclusion of duplicates, 953 articles were screened based on title and abstract, 18 articles were read full text. Eventually, nine studies were included in the systematic review, and seven of these nine in the random effects meta analysis. The pooled IRR showed that use of the antiseptic.

Critical appraisal of Literature

The following quote has been received by the news editors from the background information supplied by the inventors: “The present invention relates to disinfectant caps for medical devices. More specifically, the present invention relates to disinfectant caps for luer access devices that provide direct contact with antiseptic fluid stored therein.

“Intravenous (IV) devices are widely used to administer fluids to patients, such as through the use of a catheter inserted into a patient. Usually, the catheter is connected to an injection site, such as a luer access device, which provides fluid communication from a fluid source (e.g., IV bag, syringe, etc.) to the patient. The connectors are frequently separated from each other (e.g., when a patient needs to use the bathroom), which exposes the connectors to the environment, which can result in contamination.” (Excelsior medical corporation, 2016)

“To reduce the risk of contamination, the connectors are usually disinfected between uses. Current procedures include swabbing the connectors with a disinfecting pad, which is prone to human error and not often implemented. Existing antiseptic caps utilize the corresponding female luer thread geometry to secure the capto the injection site. However without the additional tapered luer tip geometry, which secures these types of connections between syringes and injection sites, the antiseptic caps do not securely fit on the injection site, and are prone to falling off inadvertently.”

In addition to the background information obtained for this patent application, VerticalNews journalists also obtained the inventors’ summary information for this patent application: “The present invention relates to disinfectant caps and packaging for use with a medical device (e.g., connector, luer access device, etc.). The disinfectant caps apply the antiseptic fluid (e.g., disinfectant) directly onto the surface of the medical device. The disinfectant caps incorporate specific thread geometry to provide a secure fit to threaded access sites.

Develop an EBP standard

The American health care system is under intense scrutiny as national reform efforts are directed toward decreasing costs and improving accessibility to services for all citizens. Quality and efficiency are crucial to the sustainability of both the profit margin and the mission of organizations, with the elimination of preventable hospital-acquired conditions being a major focus. Avoidable infections are a source of increased morbidity and inflated costs, causing longer lengths of stay and needless human suffering.The Centers for Medicare and Medicaid Services stopped reimbursing facilities for the treatment of certain preventable infections, urging greater accountability to higher standards of patient safety. (Smith, et al., 2012)

Catheter-related bloodstream infections (CRBSIs) are among these largely preventable conditions. According to the Centers for Disease Control and Prevention, a total of 80,000 cases of CRBSI occur annually in the United States in intensive care units alone. If entire hospitals are assessed, the number increases to 250,000. O’Grady et al1 reported an approximate cost of $25,000 per episode and an attributable mortality rate of 12% to 25%. These alarming statistics call for the concerted and sustained effort of health care providers to prioritize and maximize patient safety through the reduction or elimination of CRBSI.

Implications

Background. Needleless connectors (NC) are used on virtually all intravascular devices, providing an easy access point for infusion connection. Colonization of NC is considered the cause of 50% of postinsertion catheter-related infections. Breaks in aseptic technique, from failure to disinfect, result in contamination and subsequent biofilm formation within NC and catheters increasing the potential for infection of central and peripheral catheters. Methods. This systematic review evaluated 140 studies and 34 abstracts on NC disinfection practices, the impact of hub contamination on infection, and measures of education and compliance. Results. The greatest risk for contamination of the catheter after insertion is the NC with 33-45% contaminated, and compliance with disinfection as low as 10%.

The optimal technique or disinfection time has not been identified, although scrubbing with 70% alcohol for 5-60 seconds is recommended. Studies have reported statistically significant results in infection reduction when passive alcohol disinfection caps are used (48-86% reduction). Clinical Implications. It is critical for healthcare facilities and clinicians to take responsibility for compliance with basic principles of asepsis compliance, to involve frontline staff in strategies, to facilitate education that promotes understanding of the consequences of failure, and to comply with the standard of care for hub disinfection.

References:Blood diseases and conditions – sepsis; findings from sophia children’s university hospital in the area of sepsis reported (antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis). (2017, Jun 08). Blood Weekly Retrieved from https://search.proquest.com/docview/1904578850?accountid=34574Excelsior medical corporation; “disinfectant caps” in patent application approval process (USPTO 20160045629). (2016, Mar 10). Politics & Government WeekRetrieved from https://search.proquest.com/docview/1770949112?accountid=34574

Smith, Judy S, MSN,R.N., C.R.N.I., Irwin, Gwen, RN,C.R.N.I., V.A.-B.C., Viney, Mary, MSN, RN,C.P.H.Q., N.E.A.-B.C., Watkins, Lynda, MPH, BSN,R.N., C.I.C., Morris, Shonnie Pinno, BSMT,A.S.C.P., S.M., PhD, K. M., & Brown, A., PhD. (2012). Optimal disinfection times for needleless intravenous connectors.Journal of the Association for Vascular Access, 17(3), 137-143. Retrieved from https://search.proquest.com/docview/1173329977?accountid=34574

Voor In ‘t Holt AF, Helder OK, Vos MC, Schafthuizen L, Sülz S, van den Hoogen A, Ista E. (2017). Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28130997