A nurse-led study has found the use of alcohol-impregnated disinfection caps has significantly reduced the number of central line-associated bloodstream infections among patients at Loyola University Medical Center in Maywood. Nurses at the hospital say the caps are easy to use and save them time during their nursing rounds.
Loyola officials say the use of the alcohol-impregnated caps has allowed the hospital to achieve a 68% reduction in CLABSI cases over a 12-month period. A two-year study compared the use of disinfection caps to an intense scrub-the-hub intervention.
Scrub-the-hub refers to cleaning catheter connector hubs and injection ports with alcohol for a recommended 15 seconds before accessing the central line, a catheter placed in a large vein to deliver medicine and liquids during hospitalization.
Marcelina M. Wawrzyniak, RN, MSN, study author and infection preventionist at LUMC, found about 80% percent of the infections occurring in the scrub-the-hub arm were linked to not scrubbing the hub for the required full 15 seconds. Wawrzyniak said she was not surprised the disinfection caps decreased the number of infections from 59 to 23 in a 12-month period.
The department had historically done a lot of work in other methodologies for disinfecting the hubs, including scrub-the-hub. This study really confirmed what we thought would be helpful in reducing CLABSI, said Wawrzyniak, who received the Young Investigator Award as primary author of the Loyola study. Wawrzyniak presented the study in June at the annual conference of the Association for Professionals in Infection Control and Epidemiology.
A disinfection cap has an advantage in that it is already clean and its good to go, helping save nurses time and ensuring the ports are clean, said Rebecca Anderson, RN, BSN, an ICU nurse at Loyola University Medical Center.
‘Easy to use’
They are really easy to use, you just pop one off and pop a new one on and dispose of the old one, Anderson said. They are easier to use because if you are in a hurry and you have to give medication, you can just prime whatever youre going to do and grab your medication and give it, instead of taking that 15 seconds to clean the port and be waiting around.
Using the disinfection caps means one less thing nurses have to be concerned about during their busy day. For Diana Matz, RN, an ICU nurse at LUMC, the scrub-the-hub method required significant concentration and attention to detail.
They advised us to wipe five times three different ways, maybe clockwise or counterclockwise, she said. Thats what I used to think about, five to the right, five to the left and five across the top.
With the alcohol-impregnated caps, its one less thing to think about and its safer for the patient, she said. The nice thing about them [is that] you know that the end of your ID cap or central line port has been saturated in alcohol.
Pilot work that showed substantial reduction in infections was done on a smaller scale and we used that to justify to scaling up hospital-wide, said Jorge Parada, MD, MPH, FACP, FIDSA, professor of medicine at Loyola University Chicago Stritch School of Medicine. We were very relieved we were proven to be correct as was the hospital when they saw their investment in this technology paid off soundly, he said.
Reduced hospital costs
In addition to improving patient safety, the disinfection caps have helped reduce hospital costs by more than $1 million, according to a Loyola news release. The cost of CLABSI is estimated at $45,814 per infection, according to a recent analysis published in the Journal of American Medical Association Internal Medicine.
We found both scrub-the-hub and the disinfection caps decreased centralized infections, but what we found is four-fifths of all blood infections in the scrub-the-hub arm happened in the last three or four months of the study, which to us reflected it was not a sustainable intervention, Parada said.
Parada said Wawrzyniak, who has been a nurse for six years and an infection preventionist at Loyola for fewer than two years, deserves tremendous credit for leading such an important study.
Robin Farmer is a freelance writer.