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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
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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
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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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.

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