Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-10T05:12:21.278Z Has data issue: false hasContentIssue false
  • English
  • Français

Alcohol-impregnated caps and ambulatory central-line–associated bloodstream infections (CLABSIs): A randomized clinical trial

Published online by Cambridge University Press:  12 October 2020

Aaron M. Milstone ,
Carol Rosenberg ,
Gayane Yenokyan ,
Danielle W. Koontz Open the ORCID record for Danielle W. Koontz [Opens in a new window] ,
Marlene R. Miller  and
for the CCLIP Authorship Group
Aaron M. Milstone*
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
Carol Rosenberg
Affiliation:
Department of Pediatrics, Division of Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland Present affiliation: Children’s Hospital Association (current), Washington, DC
Gayane Yenokyan
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Danielle W. Koontz
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
Marlene R. Miller
Affiliation:
Department of Pediatrics, Division of Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Present affiliation: Department of Pediatrics (current), UH Rainbow Babies and Children’s Hospital, Cleveland, Ohio and Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Author for correspondence: Aaron M. Milstone, E-mail: amilsto1@jhmi.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the effect of 70% isopropyl alcohol–impregnated central venous catheter caps on ambulatory central-line–associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients.

Design:

This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial.

Setting:

The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics.

Participants:

All patients with an external central line followed at 1 of the 16 hematology-oncology clinics.

Intervention:

Usual ambulatory central-line care per each institution using 70% isopropyl alcohol–impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol–impregnated caps.

Results:

Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol–impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63–1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52–0.99). No adverse events were reported.

Conclusions:

Isopropyl alcohol–impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol–impregnated caps in the ambulatory setting.

Registration:

ClinicalTrials.gov; NCT02351258

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 431 - 439
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

CCLIP authorship group: Jeffrey Hord, MD, Akron Children’s Hospital, Akron, OH; Roland Chu, MD, Children’s Hospital of Michigan, Detroit, MI; Judith Guzman-Cottrill, DO, Doernbecher Children’s Hospital, Portland, OR; Allen Chen, MD, PhD, MHS, Johns Hopkins University, Baltimore, MD; Michelle Hudspeth, MD, Medical University of South Carolina Children’s Hospital, Charleston, SC; Renee Gresh, DO, Alfred DuPont Hospital for Children, Wilmington, DE; Frederick Huang, MD, St. Louis Children’s Hospital, St. Louis, MO.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

References

Pulte, D, Gondos, A, Brenner, H. Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990–2004. J Natl Cancer Inst 2008;100:1301–1309.Google ScholarPubMed
Pulte, D, Gondos, A, Brenner, H. Trends in survival after diagnosis with hematologic malignancy in adolescence or young adulthood in the United States, 1981–2005. Cancer 2009;115:4973–4979.CrossRefGoogle ScholarPubMed
Rinke, ML, Milstone, AM, Chen, AR, et al. Ambulatory pediatric oncology CLABSIs: epidemiology and risk factors. Pediatr Blood Cancer 2013;60:1882–1889.CrossRefGoogle ScholarPubMed
Hord, JD, Lawlor, J, Werner, E, et al. Central-line–associated bloodstream infections in pediatric hematology-oncology patients with different types of central lines. Pediatr Blood Cancer 2016;63:1603–1607.CrossRefGoogle ScholarPubMed
Rinke, ML, Chen, AR, Milstone, AM, et al. Bringing central-line–associated bloodstream infection prevention home: catheter maintenance practices and beliefs of pediatric oncology patients and families. Jt Comm J Qual Patient Saf 2015;41:177–185.Google ScholarPubMed
Rinke, ML, Bundy, DG, Chen, AR, et al. Central-line maintenance bundles and CLABSIs in ambulatory oncology patients. Pediatrics 2013;132:e1403–e1412.CrossRefGoogle ScholarPubMed
Sweet, MA, Cumpston, A, Briggs, F, Craig, M, Hamadani, M. Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central-line–associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. Am J Infect Control 2012;40:931–934.CrossRefGoogle Scholar
Wright, MO, Tropp, J, Schora, DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:33–38.CrossRefGoogle ScholarPubMed
Merrill, KC, Sumner, S, Linford, L, Taylor, C, Macintosh, C. Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. Am J Infect Control 2014;42:1274–1277.CrossRefGoogle ScholarPubMed
Patel, PA, Boehm, S, Zhou, Y, et al. Prospective observational study on central-line–associated bloodstream infections and central venous catheter occlusions using a negative displacement connector with an alcohol disinfecting cap. Am J Infect Control 2017;45:115–120.CrossRefGoogle ScholarPubMed
Ramirez, C, Lee, AM, Welch, K. Central venous catheter protective connector caps reduce intraluminal catheter-related infection. J Assoc Vascular Access 2012;17:210–213.CrossRefGoogle Scholar
Moulton, LH. Covariate-based constrained randomization of group-randomized trials. Clin Trials 2004;1:297–305.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN) patient safety component manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/validation/2016/pcsmanual_2016.pdf. Published January 20, 2016. Accessed Spetember 2020.Google Scholar
National Healthcare Safety Network (NHSN) patient safety component manual master organism list. Centers for Disease Control and Prevention website http://www.cdc.gov/nhsn/XLS/master-organism-Com-Commensals-Lists.xlsx. Published January 20, 2016. Accessed September 2020.Google Scholar
Wong Quiles, CI, Gottsch, S, Thakrar, U, Fraile, B, Billett, AL. Healthcare institutional charges associated with ambulatory bloodstream infections in pediatric oncology and stem cell transplant patients. Pediatr Blood Cancer 2017;64:324–329.CrossRefGoogle ScholarPubMed
Voor In ‘t Holt AF, Helder, OK, Vos, MC, et al. Antiseptic barrier cap effective in reducing central-line–associated bloodstream infections: a systematic review and meta-analysis. Int J Nurs Stud 2017;69:34–40.Google Scholar
Dandoy, CE, Kelley, T, Gaur, AH, et al. Outcomes after bloodstream infection in hospitalized pediatric hematology/oncology and stem-cell transplant patients. Pediatr Blood Cancer 2019;66:e27978.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Milstone et al. supplementary material

Milstone et al. supplementary material 1

Download Milstone et al. supplementary material(PDF)
PDF 378 KB
Supplementary material: File

Milstone et al. supplementary material

Milstone et al. supplementary material 2

Download Milstone et al. supplementary material(File)
File 1.1 MB