Integrative Review: Disinfectant Caps and CLABSI
Ashley Morris, Senior BSN Student
Introduction
The purpose of this integrative review is to examine
current literature regarding alcohol disinfectant caps
versus other methods in reducing central line associated
bloodstream infection (CLABSI) rates.
30,100 estimated CLABSI occur in the US each year
1 in 4 of these patients will die (22,000) people each
year
33-45% hubs are contaminated with normal patient use
$12,378 estimate increased cost a single CLABSI
PICO Question
Is the infection rate in hospitalized patients with central
lines reduced by utilizing alcohol disinfectant caps versus
other practices/methods?
Methods
Method: Integrative Review
Database: PubMed
Search Terms: disinfectant cap, scrub the hub,
needleless connector, passive disinfectant,
qualitative and central line, and catheter related
infection and qualitative
Yielded: 209 articles
Inclusion Criteria
Published between 2010-2015
English language, Peer-reviewed articles
Relevance: disinfectant caps versus scrub the hub,
effectiveness of changing needleless connectors,
and nursing perspective of central line care
Results
Four quantitative and one qualitative research
articles
Chris-Tenna Perkins, PhD, RN, ANP, CNE
Bon Secours Memorial College of Nursing
Results
Alcohol Wipe Vs Disinfectant Cap
>40% decrease in rate of CLABSI per
1,000 central line days with
implementation of cap (Merrill, 2014)
A multi-phase study revealed (Wright, 2013)
Decrease in number of bacteria
P1=12.7% (wipe)
P2= 5.5% (cap) (p =.002)
Decrease in organism density
P1=4 CFU/mL (wipe)
P2=1 CFU/mL (cap)
(p =.009)
Systematic review revealed CLABSI
reduction rates as high as 61% with
the use of disinfectant caps (CI 95%)
(Moureau & Flynn, 2015)
Needleless Connector Change
CDC recommends changing needleless
connectors every 24 hours when blood
or lipids are infused; however..
A multi-phase study found that CLABSI References
rates increased from 0.41 and 0.03 per
1,000 central line days to 3.56 following
the CDC recommendation (p=.003)
(Sandora et al, 2014)
Nursing Perspective and
Compliance
I dont scrub the hub for 15
seconds, and I know of no nurse that
does (Morrison, 2012)
Hub disinfection compliance is only
38.7%, leaving 61% of line access
without disinfection prior to use
(Moureau & Flynn, 2015)
Conclusion
Emphasis on the importance of proper
and consistent disinfection of central
lines to reduce the rate of CLABSIs.
Additional research to evaluate patient
outcomes after disinfectant cap
implementation needs to be performed.
Re-evaluation of current guidelines
from the CDC may be necessary to
reduce the risk of CLABSI in patients
receiving multiple blood and/or lipid
infusions.
Education should be implemented and
integration of products such as
disinfectant caps can reduce human
factors that contribute to CLABSIs.
Merrill, K., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact
of universal disinfectant cap implementation on central line-associated
bloodstream infections. American Journal of Infection Control, 42(2014), 1274-
1277.doi: 10.1016/j.ajic.2014.09.008
Morrison, T. (2012). Qualitative analysis of central and midline care in the
medical/surgical setting. Clinical Nurse Specialist, November/December, 323-
328. doi: 10.1097/NUR.0b013e31826e3f2a.
Moureau, N., Flynn, J. (2015). Disinfection of needleless connector hubs:
Clinical evidence systematic review. Nursing Research and Practice, Volume
2015, 1-20. doi: 10.1155/2015/796762
Research Triangle Institute for Center for Medicare & Medicaid Services.
Analysis report: Estimating the incremental costs of hospital-acquired
conditions (HACs). 2012. http://www.cms.gov/Medicare/Medicare-Fee-for-
ServicePayment/HospitalAcqCond/index.html.
Sandora, T., Graham, D., Conway, M., Dodson, B., Potter-Bynoe, G.,
Margossian, S. (2014). Impact of needleless connector change frequency on
central line associated bloodstream infection rate. American Journal of Infection
Control, 42 (2014), 485-489. doi: 10.1016/j.ajic.2014.01.022
Wright, M., Tropp, J., Schora, D., Dillon-Grant, M., Peterson, K., Boehm,
S.,Peterson, L. (2013). Continuous passive disinfection of catheter hubs
prevents contamination and bloodstream infection. American Journal of
Infection Control, 41 (2013), 33-38. doi: 10.1016/j.ajic.2012.05.030