Universal Intravenous Access Cleaning Device Fails to Sterilize Stopcocks

Holroyd, Julie L.; Paulus, David A.; Rand, Kenneth H.; Enneking, F. Kayser; Morey, Timothy E.; Rice, Mark J.

doi:10.1213/ane.0000000000000059

Cited by 16 publications

(16 citation statements)

References 15 publications

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“…These studies suggest that while both open and closed lumen intravascular devices can be disinfected, DNCCs are more easily decontaminated. Future work should more extensively compare the efficacy of different hub disinfection systems in reducing contamination of DNCCs in the clinical environment [19].…”

Section: Key Pointsmentioning

confidence: 99%

Infection control in the operating room

Loftus

2016

Current Opinion in Anaesthesiology

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Recent work has led to the development of evidence-based hand hygiene, environmental cleaning, patient decolonization, and intravascular catheter design and handling improvement strategies. Evidence suggests that a best practice for postoperative infection control is a multimodal program that utilizes these interventions to target patient, provider, and environmental reservoirs in parallel. The development of novel diagnostic tools for targeted attenuation of hyper virulent, transmissible and resistant strains/strain characteristics is indicated to improve patient decolonization efforts.

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Section: Key Pointsmentioning

confidence: 99%

Infection control in the operating room

Loftus

2016

Current Opinion in Anaesthesiology

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“…The Holroyd in vitro study at University of Florida compared the single use of this cleansing cap with 70% alcohol to traditional 70% alcohol wipes [151]. When the cleansing cap was used on stopcocks Holroyd found contamination and increased CFU.…”

Section: Passive Disinfectionmentioning

confidence: 99%

“…When the cleansing cap was used on stopcocks Holroyd found contamination and increased CFU. This study found 70% alcohol wipes and this alcohol cleansing cap were both effective on the surface of NC and catheter hubs [151]. Other groups also used this single use cleansing cap in combination with other 70% alcohol disinfecting caps designed to be left in place until the next access [14,177].…”

Section: Passive Disinfectionmentioning

confidence: 99%

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

Moureau¹

2015

Journal of the Association for Vascular Access

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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.

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“…For diseases with high fatality rates that lack specific and effective treatment, it is prudent to take a more extreme prevention strategy than that based on the documented transmission route. 2 One example in which this strategy is applied is Ebola virus disease, for which extreme precautions are taken. 3 Given that SFTS virus (SFTSV) is a viral hemorrhagic fever virus that causes severe disease with a high fatality rate, we apply the same strategy to SFTS.…”

mentioning

confidence: 99%

“…To date, airborne transmission of naturally occurring hemorrhagic fever viruses has not been documented. 2 The patient in the Moon et al article was a doctor wearing only a fluid-shield mask and gloves who performed endotracheal intubation on an SFTS patient and was infected with SFTS thereafter. Respiratory droplets are thought to be generated during endotracheal intubation, and protection of the eyes, nose, and mouth is recommended during the procedure in accordance with standard precautions.…”

mentioning

confidence: 99%

New SHEA expert guidance for infection prevention in the anesthesia work area needs improvement

Greene

2019

Infect. Control Hosp. Epidemiol.

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To the Editor-The recent SHEA Expert Guidance article 1 addresses the following questions: "Should injection ports used by anesthesia providers in the OR be covered with isopropyl alcohol-containing caps? Should injection ports-without alcohol-containing caps-used by anesthesia providers in the OR be scrubbed with alcohol before each use?" SHEA recommends that intravenous "ports may be disinfected either by scrubbing the port with a sterile alcohol-based disinfectant before each use immediately prior to each use or using sterile isopropyl alcohol containing caps that cover ports continuously : : : [and that] : : : Ports should be properly disinfected prior to each individual drug injection : : : " Yet this will not provide effective disinfection of the internal surface of open-lumen stopcocks. 2 When the internal surface is contaminated, neither an alcohol pad nor a cap with alcoholimpregnated pads is effective. 2 Disinfectable, needleless, closed connectors are effectively disinfected with either treatment. 2 It is very difficult to stop contamination of open-lumen stopcocks, 2 whereas closed ports can be disinfected. 3 SHEA further recommends that "Stopcocks should have closed injection ports installed to convert them into "closed ports," or they should be covered with sterile caps." Unfortunately, this recommendation indicates an infection control equivalence to using either closed injection ports or sterile caps. The recommendation to use a sterile cap does not reduce the infectious risks of open-lumen stopcocks used commonly in anesthesia practices nationwide. Open-lumen stopcocks traditionally use sterile caps, but it is well documented that during use the cap and the stopcock's internal lumen can become contaminated by bacteria, in up to 32% of cases, and these occurrences are associated with increased patient morbidity and mortality. 3-5 Even if a new sterile cap is placed on a stopcock after each access (which is not addressed by SHEA), the cap and internal lumen can still become contaminated due to inadvertent contact with a contaminated hand, glove or other surface during cap placement. The risks are clear: "A common route to intravascular device-related bloodstream infections is bacterial contamination of the injection port, which leads to hub colonization, intraluminal migration, and distal seeding of the bloodstream." 2 The rate of catheter-related bloodstream infections (CRBSIs) is lower with central venous catheters using disinfectable needle-free connectors than with open-lumen stopcocks (0.7 vs 5.0 per 1,000 catheter days). 6 Mahida et al 7 reported that 9% of cases had bacterial contamination in intravenous extension lines connected to open-lumen

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Universal Intravenous Access Cleaning Device Fails to Sterilize Stopcocks

Cited by 16 publications

References 15 publications

Infection control in the operating room

Infection control in the operating room

Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

New SHEA expert guidance for infection prevention in the anesthesia work area needs improvement

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