The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients

Abstract

Purpose: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. Results: The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

“…More specifically, CRBSI-free catheter survival did not differ significantly between citrate (-antimicrobials) and heparin locks with jugular vein catheters, which is consistent with the results of Zhao et al and Mai et al, while with subclavian catheters CRBSI-free survival was significantly lower with citrate locks (Barcellos et al, 2017). Other studies on the efficacy of citrate locks against CRBSI highlight on the significance of asepticcatheter manipulation in accordance to CDC guidelines, as imperfect sterility may compromise locking efficiency (Cooney et al, 2020). To conclude, citrate may be an effective anticoagulant alternative to heparin and contribute to CRBSI risk reduction in combination with antimicrobials but further research is required for the standardization of detailed protocols (May et al, 2019).…”

Central Venous Catheters for Hemodialysis—the Myth and the Evidence

“…This involves using a scrubbing device with chlorhexidine and alcohol to J o u r n a l P r e -p r o o f disinfect the catheter hub and stopcocks. One observational study that was conducted to assess the efficacy of the 'scrub the hub' protocol prior to accessing central line hubs depicted a 65% reduction in CR-BSI events in the inpatient dialysis population in the post-implementation period (P value = 0.0493) [72].…”

“…One observational study that was conducted to evaluate the efficacy of the “scrub the hub” protocol before accessing central line hubs depicted a 65% reduction in CR-BSI events in the inpatient dialysis population in the postimplementation period ( P = 0.0493). 71 …”

Association of qacA/B and smr Carriage with Staphylococcus aureus Survival following Exposure to Antiseptics in an Ex Vivo Venous Catheter Disinfection Model

“…CHG is a biguanide antiseptic that nonspecifically disrupts the bacterial cell wall and interferes with the cellular membrane potential of numerous microorganisms, including Gram-positive and Gram-negative bacteria as well as yeasts ( 7 ). CHG-containing products in a variety of formulations have been shown to decrease the rates of HAIs ( 8 – 11 ). Such strategies have been endorsed by the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) for the prevention of HAIs ( 12 – 14 ).…”

“…In hospitalized patients with central venous catheters, bathing with CHG has been associated with reduced rates of bloodstream infections ( 8 ). Furthermore, CHG and CHG-alcohol solutions are commonly used in central venous catheter insertion and maintenance procedures, as well as for cleansing of the catheter hub prior to the administration of medications/fluids ( 11 , 13 ). Therefore, we sought to evaluate the ability of smr - and qacA/B -positive S. aureus clinical strains to resist disinfectant killing in an ex vivo venous catheter disinfection model.…”