scrub site bard device ipa alcohol sterile isopropyl box flash sorry player blowoutmedical This reduction equated to an estimated annual saving of US$3.2 million. : Springer; 2019. There was no significant difference between the two operators in terms of log10 CFU reduction of S. aureus following 15s decontamination with a 2% (w/v) CHG in 70% (v/v) IPA wipe and drying for 30s for both the MicroClave (4.69, 95% CI=3.565.29 vs 4.61, 95% CI=3.995.21, P=0.73) and CareSite (5.10, 95% CI=4.11-TK vs 5.10, 95% CI=3.04-TK, P=0.32). Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central lineassociated bloodstream infections in acute care hospitals: 2014 update. Terms and Conditions, Decontamination of both types of needle-free device with a 2% (w/v) CHG in 70% (v/v) IPA wipe both following inoculation with S. aureus and following each subsequent incubation period resulted in a higher log10 CFU reduction as compared to only cleaning following contamination for MicroClave only (P=0.009). Thokala P, Arrowsmith M, Poku E Economic impact of Tegaderm chlorhexidine gluconate (CHG) dressing in critically ill patients. 186 0 obj <>stream

https://doi.org/10.1186/s13756-018-0342-0, DOI: https://doi.org/10.1186/s13756-018-0342-0. There is a body of evidence indicating that use of disinfecting caps represents good clinical practice. Advances in treatment often entail extended indwell times for central vascular access devices. They found that use of the caps was associated with a 34% decrease in CLABSI rates in these high-risk patients. An overnight culture of Staphylococcus aureus National Collection of Type Cultures (NCTC) 6538 on tryptic soy agar (Oxoid) was used to prepare a 1108CFU/mL suspension in tryptone sodium chloride (1g/L tryptone [Oxoid], 8.5g/L NaCl [Sigma-Aldrich] in distilled water) containing 3g/L bovine albumin faction V [VWR International] and 3ml/L defibrinated sheep blood [TCS Biosciences] in accordance with BS EN 16615:2015 [13]. : Elsevier; 2014. Loveday H, Wilson J, Pratt R epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Stango C, Runyan D, Stern J, Macri I, Vacca M. A successful approach to reducing bloodstream infections based on a disinfection device for intravenous needleless connector hubs.

PubMedGoogle Scholar. Any exposed part of a catheter can harbour bacteria.

Routine practice in all healthcare organisations should comprise consistent implementation of a standardised approach; the best way of achieving this is to use care bundles (Stevens and Schulman 2012; Hugill, 2017). The reasons for this difference in efficacy of the cap versus wipe is unresolved but may reflect the continuous antimicrobial activity of the decontamination offered by the caps rather than the relatively short time following the wipes. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: a summary and review of peripherally inserted central catheter and venous catheter appropriate use. This was the case for both types of needle-free connectors tested during this study, demonstrating the efficacy across more than one specific device. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Studies, such as Curran (2016), have shown that colonisation of the NFC or the presence of intraluminal biofilm can result in pathogens finding a way into the internal lumen of the IV catheter and then into the bloodstream. curos closed system cap disinfecting stopper luers female open 3m maintain hold pressure Healthcare-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors. 2013;41:338. Casey, A.L., Karpanen, T.J., Nightingale, P. et al. Further research and evidence on the use of disinfecting caps on peripheral cannulae would be justified. St Jude's Church, Dulwich RoadLondon SE24 0PB. Clin Infect Dis.

The dressing should be left in place for 7 days, during which time it should not be disturbed unless debris is visible under the dressing or the dressing starts to lift (Royal College of Nursing (RCN), 2016). Also known as port protectors, these are devices that are impregnated with an antiseptic agent and connected to the luer fitting of a NFC when it is used with a central or peripheral line. This study demonstrated that under controlled laboratory conditions a disinfection cap containing 70% (v/v) IPA was more effective at reducing microbial contamination of contaminated injection ports of needle-free connectors when compared to cleaning with 2% (w/v) CHG in 70% (v/v) IPA wipes even for 15s. Indeed, the study demonstrated that the caps were associated with a significantly higher log10 CFU reduction than a 2% (w/v) CHG in 70% (v/v) IPA wipe at 1, 3 and 7 days and a two-clean regime used at 7 days. The study concluded that different types of NFCs might be associated with different risks of internal microbial contamination. 2014. Many devices and systems are currently available, with more innovations expected. They are available in a variety of formats and their adoption will depend on the healthcare organisation and its needs. JBI Database Systematic Rev Implement Rep.. Copyright 2022 Mark Allen Group | Registered in England No. Stango C, Runyan D, Stern J, Macri I, Vacca M. A successful approach to reducing bloodstream infections based on a disinfection device for intravenous needleless connector hubs. Provided by the Springer Nature SharedIt content-sharing initiative. It has also been suggested that surface disinfection of needle-free connectors is not intuitive which may lead to non-compliance [5]. 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. Indeed, no differences in log10 CFU reductions between these devices were observed. Nullification of antimicrobial activity and non-microbial toxicity was verified prior to commencement of the study (unpublished data). In the author's experience, this can make organisations feel safer and well-led, which will reassure their users and increase confidence in care. Despite these advances, the risk of complications persists, so the priority remains to focus on the basics. Cameron-Watson C. Port protectors in clinical practice: an audit. The 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. curos 3m cap disinfecting strip luers male tips cm5 female Reducing the degree of colonisation of venous access catheters by continuous passive disinfection.

In a survey of 1237 UK hospital departments, it was reported that 77% of IV hubs were being cleaned for 25 seconds, 54% for 10 seconds and 30% for 5 seconds; all of these timings sit outside national guidance (Rawlinson, 2014). Health Protection Agency. Care bundles provide a structured framework for delivering evidence-based care: they generally comprise a set of three to five clinical practices, some of which may relate to the use of devices, that when performed collectively and reliably, have been proven to improve patient outcomes (Institute for Healthcare Improvement, 2019). Antimicrob Resist Infect Control 7, 50 (2018).

2014;40(12):12747. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings.

Wallis MC, McGrail M, Webster J Risk factors for peripheral intravenous catheter failure.

The. This can be important for patients with a tunnelled renal catheter, which should only be used for dialysis. : CRC Press; 1994.

This safety risk was highlighted in a study by Casey et al (2018), which investigated the differences in microbial ingress between six different NFCs. The aim of the study sample size was to demonstrate that each decontamination method achieved a 5 log10 reduction in the number of S. aureus (or 99.999% reduction). NFCs can also reduce the risk of other complications, such as occlusion, air embolism and thrombosis, and extend the life of the VAD (Kelly et al, 2017). The application of the disinfection cap resulted in a significantly higher log10 CFU reduction of the 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. picc disinfectant Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test. California Privacy Statement, Am J Infect Control. Curos: national IV port cleaning survey results. Fronzo C. Approaches for standardising best practice to reduce CRBSIs and CLABSIs. However, it seems that the amount of time required to disinfect a NFC is often overlooked by health professionals. endstream endobj startxref

Disinfection caps were attached to the needlefree-connectors for 1, 3 or 7 days and were compared with needle-free connectors cleaned with a 2% (w/v) CHG in 70% (v/v) IPA wipe. However, the selected decontamination regimen used in this current study is representative of the outpatient scenario where central venous catheters may be accessed just once a week during clinic visits. Frasca D, Dahyot-Fizelier C, Mimoz O. Following one activation of each connector, the external injection port of each sterile needle-free connector were inoculated with a 50L suspension containing at least 5106 CFU of S. aureus and allowed to air dry for 4h at 20C. Google Scholar. 2018.

2022 BioMed Central Ltd unless otherwise stated.

Health professionals are more likely to pay attention to a catheter lumen if there is a brightly coloured cap protecting the hub from clinical misuse. Kallen AJ, Patel PR, O'Grady NP. van Cott H. Human errors: their causes and reduction. Fort Lauderdale; 2013. p. E64. In contrast, intraluminal CRBSI remains the most significant infection complication but, unlike extraluminal infections, it might not be visible. Institute for Healthcare Improvement. The FDA requested that manufacturers of positive-displacement devices should conduct post-market surveillance to demonstrate that their devices were not associated with an increased risk of BSI compared to other types of device. Choi SW, Chang L, Hanauer DA Rapid reduction of central line infections in hospitalized paediatric oncology patients through simple quality improvement methods. When CRBSI rates are high, the cost to the patient and the organisation can be significant. BS EN 16615:2015. curos cap disinfecting 3m needleless connector attaching caps connectors states united packaging strip Recent evidence demonstrates that passive disinfecting caps are effective in maintaining a low rate of CLABSI. Curran E. Needleless connectors: the vascular access catheter's microbial gatekeeper. Holzmann-Pazgal G. Central line-associated bloodstream infection (CLABSI). McGuire R. Assessing standards of vascular access device care. In contrast, the term CLABSI is used for surveillance only. Lee J. Disinfection cap makes critical difference in central line bundle for reducing CLABSIs. Strategies to prevent central line-associated bloodstream infections in acute care hospitals.

Moureau NL, Marsh N, Zhang L Evaluation of skin Colonisation and placement of vascular access device exit sites (ESCAPE study). If NFCs have been insufficiently cleaned or are touched after disinfection, there is a risk that bacteria could be injected into the vascular system when they are next used (Percival et al, 2014). Another confounding factor is compliance to decontamination of needle-free connectors in clinical practice. Manufacturers and suppliers of the most commonly used NFC advise that the disinfected area should be left to dry for 30 seconds or until visibly dry (Clinell, 2015). This would be the case in clinical areas where IV devices are frequently accessed such as in critical care. J Infus Nurs. All these advantages present a persuasive argument to utilise these devices in clinical practice. It showed that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices. 0 Most healthcare organisations use a wipe impregnated with 2% chlorhexidine and 70% alcohol, which has been proven to decontaminate NFCs if applied for 30 seconds, as recommended by evidence-based guidelines such as Epic3 (Loveday et al, 2014; Infusion Therapy Society (INS) standards, 2016; RCN, 2016). TSJE and TJK have received honoraria from 3M for attendance at advisory board meetings and presentations at symposia. Royal College of Nursing.

NFCs are handled regularly when a catheter is in use, which is one reason why they need to be disinfected before use (Curran, 2016). Google Scholar. cap excelsior

Antimicrobial Resistance & Infection Control

The caps act as passive disinfection devices which are designed to ensure that needle-free connectors are always clean. CAS cap curos disinfecting 3m luers female open protectors port stopper poles dispensed hung convenient caps individual strip which access

2016. Published evidence suggests that, among health professionals, adherence to best practice on the manual disinfection of NFC hubs is often poor, Passive disinfecting caps have been developed to address this problem, when used as part of a care bundle. Madni T, Eastman AL. Cameron-Watson (2016) examined the effect of implementing the use of a passive disinfecting cap on compliance and the incidence of VAD-related bacteraemia within one hospital trust. Similarly, if the disinfection caps were employed in the inpatient clinical scenario they would be accessed and replaced more frequently. Hadaway L. Short peripheral intravenous catheters and infections. hb```@(1A#,J;>```brR.@Z032 pGp/pS(ex^_K}7Q Many factors have been attributed to the level of infection risk associated with needle-free connectors and includes the efficacy of disinfection of the injection ports [5]. Central venous catheterization. 2016. Han Z, Liang S, Marschall J. Wright MO, Tropp J, Schora DM, et al. Standards for Infusion Therapy. curos tips 3m alcohol cm5 strip isopropyl bx cap disinfecting male tubing Ramirez C, Lee AM, Welch K. Central venous catheter protective connector caps reduce intraluminal catheter-related infection. It also serves as a visual reminder that the VAD is being used and protected. We would like to thank Karen Burgess for her assistance in the laboratory. In 2016, Pronovost et al published research on the progress of the first version of the Michigan Keystone project research data, which had been initiated in 2009. The cap is compatible with the existing luer NFCs available on the market. Hugill K. Preventing bloodstream infection in IV therapy. Cookies policy. Healthcare-associated infection is a major patient safety concern that causes morbidity, mortality and increased healthcare costs. They act as a physical barrier between line accesses. It is therefore conceivable that not only the improved antimicrobial activity of the caps versus wipes together with high levels of compliance with disinfection caps may both in part account for the lower rates of CLABSI associated with their use reported in previous clinical studies.

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