Reducing the degree of colonisation of venous access catheters by continuous passive disinfection

Abstract

IntroductionThe advent of Luer-type needleless venous access catheters has been accompanied by a growing number of catheter-related bloodstream infections. Our main objective was to compare rates of colonisation and phlebitis between our standard of care and the new passive disinfection system, using a Luer SwabCap bearing a sponge impregnated with 70% isopropyl alcohol.MethodsWe performed a prospective experimental study involving patients attending our day hospital oncology unit, with central venous (CV) or peripheral venous (PV) access lines with needleless connectors for antineoplastic treatment delivery. We assessed the colonisation rate by culture of the inside of the hubs (qualitative culture) and also assessed the possible appearance of phlebitis and the extra cost of introducing the new system in our oncology day hospital; nurse satisfaction was evaluated by a questionnaire. The effectiveness of the isopropyl alcohol disinfection cap was evaluated by analysing rates of catheter colonisation and phlebitis between two groups: group 1 comprised of patients receiving the standard disinfection method and group 2 comprised of patients receiving SwabCaps on any venous access connectors. Samples were taken from the catheter lumen through a sterile swab seeded in Luria Bertani-rich broth and cultivated for at least 48 h at 37°C. We also assessed the extra cost of introducing the new system in our oncology day hospital, and nurse satisfaction was evaluated by a questionnaire.Results29 patients were included (13 in group 1 and 16 in group 2). In group 1, 56% of the samples were taken from CV access connectors versus 40% in group 2. Bacterial growth was detected in 43.7% of group 1 samples versus 0% in group 2 (p=0.006). No differences in the degree of contamination were found between CV and PV access connectors. No cases of phlebitis were observed. Nurse satisfaction with the new system was 9.2 out of a maximum score of 10. The incremental cost of incorporating the new system in our oncology unit was estimated at €1.87 836.ConclusionPassive disinfection systems help reduce colonisation of venous access catheters without requiring large economic investment or special training of health personnel.

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

“…Several clinical studies have evaluated the use of these passive disinfection devices, all of which demonstrate benefits including significant reductions in the rates of hub microbial colonisation [ 7 ], and central-line associated bloodstream infections (CLABSI) [ 8 – 12 ].…”

Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective

“…Using only one of the ports of the three-way stopcock to place a bio-connector, where medication solutions and bolus will be administered. The results of a prospective experimental study indicate that using SwabCap significantly reduced connector contamination from 43.7% to 0% (p = 0.006) [51]. If this cap is not available, the bio-connector is disinfected with alcoholic chlorhexidine at >0.5% or 70% alcohol for 30 s [4,7].…”

Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters

“…Disinfection, while widely recognised as critical, still falls foul of issues relating to adherence and on the vagaries of the person performing the cleansing process [23,25,27]. Passive NFC caps have come more to the fore in recent years through providing a passive means of continuous disinfection whilst the catheter is not in use [77][78][79][80][81][82][83][84]. A number of different approaches have been taken in the design of the disinfectant barrier cap and their mode of operation is summarised in Figure 4.…”