An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors

Abstract

BackgroundThe optimal decontamination method for needle-free connectors is still unresolved. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors.MethodsThe injection ports of needle-free connectors were inoculated with Staphylococcus aureus and allowed to dry. Disinfection caps containing 70% (v/v) isopropyl alcohol (IPA) were attached to the connectors for one, three or 7 days and were compared with needle-free connectors cleaned with 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) IPA. The number of S. aureus remaining on the injection ports was evaluated. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test.ResultsThe application of the disinfection cap resulted in a significantly higher reduction in S. aureus than the 2% (w/v) CHG in 70% (v/v) IPA wipe, achieving a > 5 Log10 reduction in CFU at each time point.ConclusionsThe disinfection caps resulted in a significantly higher reduction in S.aureus on the injection ports when compared to the use of a 2% (w/v) CHG in 70% (v/v) IPA wipe. 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.

Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease

“…Use transparent NFC, with neutral/negligible displacement, minimum dead space and luer-lock connection, for closing the access to the CVAD. 11,40,81,83,84 4. Respect the aseptic technique in the management of CVAD and during dressings changes, using only sterile, single use devices.…”

“…As an alternative to manual / active disinfection, use port protectors, that is, disinfecting caps containing 70% isopropyl alcohol which have been proven to reduce bacterial growth at the hub level and the incidence of CLABSI. 82,83,[85][86][87][88] 6. Replace the NFC at the same time as the administration set (for CVADs in use see frequency in point 9) or at the end of the infusion of blood products or in the presence of evident blood residues.…”

Needleless connector decontamination for prevention of central venous access device infection: A pilot randomized controlled trial

“…Currently, 70% IPA wipes are dominant due to low cost, availability and rapid drying 2 however the addition of CHG likely increases efficacy, 3,4 and nonrandomized studies support 70% IPA caps. 5,6 Pilot RCTs are not designed to test statistical differences in outcomes or for the effect of potential confounders or covariates such as NC/device type or patient factors. Large RCTs are needed to examine various modes and strengths of antiseptics, NC materials/designs, and monitor possible new adverse events as solutions are exposed to NCs and potentially the bloodstream.…”

“…1 The optimal antiseptic is unknown, although povidone-iodine's slow dry-time presents challenges in clinical practice. 2 Combination CHG/IPA wipes, 3,4 or IPA in a cap format 5,6 may be superior to traditional intermittent 70% IPA wipes, but no randomized controlled trials (RCTs) have been completed. Our aim was to generate feasibility and pilot data comparing 70% IPA wipes, 2% CHG in 70% IPA wipes, and 70% IPA caps.…”

Use of alcohol containing caps for preventing bloodstream infections: A randomized controlled trial

“…19 In another in vitro study, it was found that the disinfection caps containing 70% isopropyl alcohol cause a significant decline in Staphylococcus aureus in injection ports in comparison with the use of wipes containing 70% isopropyl alcohol and chlorhexidine. 20…”