The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal. Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs). We now can appreciate that the approach to reducing CLABSIs much include BOTH rigorous attention to sterile precautions during the central line placement process, but also a strict catheter maintenance protocol.
The CDC and IHI protocol for central line insertion has now become standard practice and includes the following components:
- Good handwashing
- Clinicians must wear a cap and a mask
- Cleanse the skin with chlorhexidine and allow a couple of minutes to fully dry before the sterile drape is applied.
- Operator must wear a sterile gown and gloves
- Wide sterile barrier that covers the entire bed
- An antimicrobial-impregnated catheter should be used
- An observer wearing a cap and mask should monitor the entire procedure and stop the procedure for any breaks in sterile technique
- Wide sterile occlusive dressing is used to cover the insertion site.
This study was a prospective trial in a cancer unit that analyzed whether the use of disinfection hubs over the catheter ports decreased the incidence of CLABSI any further compared with strict insertion practices alone. The investigators found that the incidence of CLABSI was decreased by about 1/3 with an OR=0.62 and the annual institutional savings with this intervention was about $3,250,000.
In addition to this intervention, a careful catheter maintenance protocol should mandate that all providers must wash their hands in advance and wear gloves and preferably masks when accessing the catheter ports. In addition, the sterile occlusive dressing should be checked regularly to make sure all edges are firmly sealed and the dressings should be changed regularly.
Kamboj M et al. Use of Disinfection Cap to Reduce Central-Line-Associated Bloodstream Infection and Blood Culture Contamination Among Hematology-Oncology Patients.Infect Control Hosp Epidemiol. 2015 Dec; 36(12):1401-8.
“Reducing to zero” the rate of central-line–associated bloodstream infections (CLABSIs) requires optimizing not only the approach to catheter insertion, but also the approach to maintaining the catheters. One recently invented approach to decrease CLABSI rates is the use of catheter-port antiseptic barrier caps that contain an antiseptic-impregnated sponge that initially disinfects the port hub during placement and thereafter physically covers the hub. Investigators have now performed a multiphase prospective trial to assess the efficacy of antiseptic barrier caps in reducing rates of CLABSIs and blood culture contamination in a single tertiary-care cancer center.
The introduction of disinfection caps was associated with a significant decrease in the hospital-wide CLABSI rate (standardized incidence ratio = 0.62). This reduction was associated with a reduction in the CLABSI rate in the three high-risk units (the intensive care unit, hematopoietic stem cell transplant unit, and leukemia-lymphoma ward) but not in the general oncology units. Use of the disinfection caps was also associated with a significant reduction in the rate of coagulase-negative staphylococcal contamination of blood cultures drawn through the catheter (SIR = 0.42). The authors estimated the annual cost of the use of the disinfection caps for this institution at approximately $202,700 and the gross cost savings from cap-related reductions in CLABSIs and contaminated blood cultures at approximately $3,472,000.- See more at: http://www.jwatch.org/na40059/2016/01/08/how-effective-are-iv-catheter-disinfection-caps?query=etoc_jwhospmed&jwd=000020032208&jspc=GP#sthash.LwoK2A17.dpuf