Does changing needleless caps reduce the rate of infections?

Posted on April 22, 2014 by Lisa

Conflicting evidence exists on whether changing needleless caps reduces the rate of infections.

Do, A N, et al. “Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting.” The Journal of infectious diseases 179.2 (1999):442-448.
Cohort study found that rate of bloodstream infections (BSIs) rate “decreased as the frequency of changing the needleless device end cap increased from once weekly up to every 2 days, suggesting that the mechanism for BSI may involve contamination from the end cap.”

McDonald, L C, S N NBanerjee, and W R RJarvis. “Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy.” Infection control and hospital epidemiology 19.10 (1998):772-777.
Bloodstream infection (BSI) rates increased in patients receiving “intermittent (vs continuous) intravenous therapy through one or more lumens. The IVAC device valvecomponent was replaced every 6 days, and the endcap used to cover the valve (when connected to an unused lumen) was replaced every 24 hours or after each access. The BSI rate returned to baseline after institution of a policy to replace the entire IVAC device, valve, and endcap every 24 hours.”

Danzig, L E, et al. “Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.” JAMA: the Journal of the American Medical Association 273.23 (1995):1862-1864.
Researchers conducted case-control and retrospective cohort studies. Data found that needleless device used for total parenteral nutrition and intralipid therapy (TPN/IL) “was associated with increased risk of BSI when injection caps were changed every 7 days.”

Is use of a secondary IV, or piggyback system, reduce the rate of central line-associated bloodstream infections?

Posted on November 25, 2013 by Amy

A search of Joanna Briggs for the term piggyback identified several evidence summaries and recommendations. Each of them cited the 2002 CDC guidelines as evidence in discussing piggyback systems.

MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
O’Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

On p. 11, the guidelines state that “modified piggyback systems have the potential to prevent contamination…” and cite this single study:

JPEN J Parenter Enteral Nutr. 1992 Nov-Dec;16(6):581-5.
Inoue Y, et al. Prevention of catheter-related sepsis during parenteral nutrition: effect of a new connection device.

A search of PubMed was conducted using the following terms:
(piggyback OR secondary iv OR (secondary AND infusion)) AND infections AND prevention AND central venous catheters

The results include the Inoue study. No other studies focus on prevention of catheter-associated bloodstream infections, but may report data on infection rates, which may also be useful. However, the populations for most of the other studies were neonates.

jkn 3/14

What is the most recent evidence on the prevention of CLABSI?

Posted on June 7, 2013 by John

Smith J. It’s Contagious! CLABSI Prevention is Spreading. American Journal Of Infection Control [serial online]. June 2012;40(5):e128-9. Available from: CINAHL, Ipswich, MA. Accessed June 5, 2013.

National Estimates of Central Line–Associated Bloodstream Infections in Critical Care Patients.” Infection control and hospital epidemiology 34.6 (2013):547.

Saffer M. Preventing Central Line Infections In Outpatients. Pediatric Nursing. November 2012;38(6):336. Available from: CINAHL, Ipswich, MA. Accessed June 5, 2013.

Prevention of catheter-related infection: toward zero risk?.” Current opinion in infectious diseases 24.4 (2011):377.

What is the recent evidence for intentional rounds in the intensive care unit?

Posted on February 9, 2012 by Amy

Searched CINAHL and PubMed for patient rounds AND (“intensive care” OR “critical care”) with a limit of English.

Six quasi-experimental studies in CINAHL measuring nurse satisfaction, ventilator-associated pneumonia, cental-line associated bloodstream infection, nosocomial infections, healthcare outcomes, family presence, and facilitators and barriers to patient care rounds
Adding intensive care or critical care eliminates many studies that may also be relevant.

(MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort)
These results include several experimental and quasi-experimental studies. If you want to look at specific outcomes, see the following searches for particular topics:

Falls – (MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort) AND falls

Patient satisfaction – (MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort) AND patient satisfaction

Patient centered care – (MH “Patient Rounds”) AND (MH “Patient centered care”)

Papers in PubMed search: (rounds OR rounding) AND (intentional OR hourly OR time factors OR proactive) AND (nurses OR nursing) AND (safety OR quality improvement OR infection OR pneumonia OR pressure ulcers OR falls OR patient satisfaction OR patient outcome assessment OR outcomes assessments) AND (“intensive care” OR “critical care”)
This search retrieves papers examining common outcomes in the intensive care unit. Other outcomes can be included in the search.

Reviewed and updated 5/1/2014 ldt

In taking a blood sample from a central venous catheter for evaluating a catheter-related infection, does discarding initial blood make a difference in contamination of the sample?

Posted on July 18, 2011 by Amy

Bottom line: In samples drawn from central venous catheters, there may not be much difference between the contamination rate of the discard and that of the blood drawn after the discard.

Summary: Dwivedi S, Bhalla R, Hoover DR, Weinstein MP. Discarding the initial aliquot of blood does not reduce contamination rates in intravenous-catheter-drawn blood cultures. J Clin Microbiol. 2009 Sep;47(9):2950-1.
This prospective study compared contamination rates of cultures of the discards to cultures of the sample taken after the discard for 653 consecutive samples on three oncology nursing units. RESULTS: Overall contamination rate was 10.9% for the discard vial versus 10.5% for the standard vial (p=0.90).

Reviewed 4/15/2014 ldt

For inpatients, is daily bathing with chlorhexidine gluconate (CHG) more effective than daily bathing with soap and water to reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enteroccocus (VRE) hospital-acquired infections (HAIs)?

Posted on March 30, 2011 by Amy

Bottom line: Use of CHG results in significant reductions in risks of central-line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and colonizations with VRE or MRSA but not reductions in infections.

Summary: Karki S, Cheng AC. “Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review.” J Hosp Infect. 2012;82(2):71-84.
This systematic review included sixteen published studies and four conference abstracts. Studies compared the use of CHG in washcloths with at least one of the following: soap and water bathing, routine advice, or no intervention.

Reviewed and updated 4/11/2014 ldt

Rates of central line-associated bloodstream infection (CLABSI) in 2001, 2008, and 2009 for ICU, inpatient, and hemodyalisis units

Posted on March 22, 2011 by Amy

Centers for Disease Control and Prevention (CDC). Vital signs: central line–associated blood stream infections — United States, 2001, 2008, and 2009. Morb Mortal Wkly Rep 2011 Mar 4; 60:243.

Includes incidence data comparing 2008-09 data to 2001, which was prior to the CDC’s 2002 guidelines for reducing CLABSIs.

Reviewed 4/11/2014 ldt

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Evidence-based information for Emory

Category Archives: CLABSIs