Skip to main content Accessibility help
×
Home
Hostname: page-component-7ccbd9845f-s2vjv Total loading time: 0.381 Render date: 2023-02-01T17:07:29.576Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Use of Disinfection Cap to Reduce Central-Line–Associated Bloodstream Infection and Blood Culture Contamination Among Hematology–Oncology Patients

Published online by Cambridge University Press:  23 September 2015

Mini Kamboj*
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
Rachel Blair
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York
Natalie Bell
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
Crystal Son
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York
Yao-Ting Huang
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Mary Dowling
Affiliation:
Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, New York
Allison Lipitz-Snyderman
Affiliation:
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
Janet Eagan
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York
Kent Sepkowitz
Affiliation:
Infection Control and Infectious Disease Service Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
*
Address correspondence to Mini Kamboj, MD, 1275 York Avenue Box 9, New York, NY 10065 (Kambojm@mskcc.org).

Abstract

OBJECTIVE

In this study, we examined the impact of routine use of a passive disinfection cap for catheter hub decontamination in hematology–oncology patients.

SETTING

A tertiary care cancer center in New York City

METHODS

In this multiphase prospective study, we used 2 preintervention phases (P1 and P2) to establish surveillance and baseline rates followed by sequential introduction of disinfection caps on high-risk units (HRUs: hematologic malignancy wards, hematopoietic stem cell transplant units and intensive care units) (P3) and general oncology units (P4). Unit-specific and hospital-wide hospital-acquired central-line–associated bloodstream infection (HA-CLABSI) rates and blood culture contamination (BCC) with coagulase negative staphylococci (CONS) were measured.

RESULTS

Implementation of a passive disinfection cap resulted in a 34% decrease in hospital-wide HA-CLABSI rates (combined P1 and P2 baseline rate of 2.66–1.75 per 1,000 catheter days at the end of the study period). This reduction occurred only among high-risk patients and not among general oncology patients. In addition, the use of the passive disinfection cap resulted in decreases of 63% (HRUs) and 51% (general oncology units) in blood culture contamination, with an estimated reduction of 242 BCCs with CONS. The reductions in HA-CLABSI and BCC correspond to an estimated annual savings of $3.2 million in direct medical costs.

CONCLUSION

Routine use of disinfection caps is associated with decreased HA-CLABSI rates among high-risk hematology oncology patients and a reduction in blood culture contamination among all oncology patients.

Infect. Control Hosp. Epidemiol. 2015;36(12):1401–1408

Type
Original Articles
Copyright
© 2015 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

PREVIOUS PRESENTATION: This work was presented in part as poster abstract session no. 119, October 19, 2012 at ID Week 2012, San Diego, California.

References

REFERENCES

1. Segura, M, Alvarez-Lerma, F, Tellado, JM, et al. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg 1996;223:363369.CrossRefGoogle ScholarPubMed
2. O’Grady, NP, Alexander, M, Burns, LA, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39:S1S34.CrossRefGoogle ScholarPubMed
3. O’Grady, NP, Alexander, M, Burns, LA, et al. Summary of recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis 2011;52:10871099.CrossRefGoogle ScholarPubMed
4. Guerin, K, Wagner, J, Rains, K, Bessesen, M. Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. Am J Infect Control 2010;38:430433.CrossRefGoogle ScholarPubMed
5. Zingg, W, Imhof, A, Maggiorini, M, Stocker, R, Keller, E, Ruef, C. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Crit Care Med 2009;37:21672173.CrossRefGoogle ScholarPubMed
6. Shapey, IM, Foster, MA, Whitehouse, T, Jumaa, P, Bion, JF. Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect 2009;71:117122.CrossRefGoogle ScholarPubMed
7. Wright, MO, Tropp, J, Schora, DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:3338.CrossRefGoogle ScholarPubMed
8. Son, CH, Daniels, TL, Eagan, JA, et al. Central line-associated bloodstream infection surveillance outside the intensive care unit: a multicenter survey. Infect Control Hosp Epidemiol 2012;33:869874.CrossRefGoogle ScholarPubMed
9. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection). Centers for Disease Control and Prevention/National Health Safety Network Web site. http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Published January 2015. Accessed August 28, 2015.Google Scholar
10. The Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Prevention. Centers for Disease Control and Prevention/National Health Safety Network Web site. http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published March 2009. Accessed August 28, 2015.Google Scholar
11. Alahmadi, YM, Aldeyab, MA, McElnay, JC, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011;77:233236.CrossRefGoogle ScholarPubMed
12. Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 1991;265:365369.CrossRefGoogle ScholarPubMed
13. Gilligan, PH. Blood culture contamination: a clinical and financial burden. Infect Control Hosp Epidemiol 2013;34:2223.CrossRefGoogle ScholarPubMed
14. Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788802.CrossRefGoogle ScholarPubMed
15. Walshe, LJ, Malak, SF, Eagan, J, Sepkowitz, KA. Complication rates among cancer patients with peripherally inserted central catheters. J Clin Oncol 2002;20:32763281.CrossRefGoogle ScholarPubMed
16. Weinstock, DM, Rogers, M, Eagan, J, Malak, SA, Sepkowitz, KA. Nosocomial central venous catheter infections among patients with different types of cancer. Infect Control Hosp Epidemiol 2002;23:234235.CrossRefGoogle ScholarPubMed
17. Dettenkofer, M, Wenzler-Rottele, S, Babikir, R, et al. Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project. Clin Infect Dis 2005;40:926931.CrossRefGoogle ScholarPubMed
18. Ruschulte, H, Franke, M, Gastmeier, P, et al. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol 2009;88:267272.CrossRefGoogle ScholarPubMed
19. Timsit, JF, Schwebel, C, Bouadma, L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301:12311241.CrossRefGoogle ScholarPubMed
20. Soothill, JS, Bravery, K, Ho, A, Macqueen, S, Collins, J, Lock, P. A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward. Am J Infect Control 2009;37:626630.CrossRefGoogle ScholarPubMed
21. Lockman, JL, Heitmiller, ES, Ascenzi, JA, Berkowitz, I. Scrub the hub! Catheter needleless port decontamination. Anesthesiology 2011;114:958.CrossRefGoogle ScholarPubMed
22. Simmons, S, Bryson, C, Porter, S. “Scrub the hub”: cleaning duration and reduction in bacterial load on central venous catheters. Crit Care Nurs Q 2011;34:3135.CrossRefGoogle Scholar
23. Rupp, ME, Yu, S, Huerta, T, et al. Adequate disinfection of a split-septum needleless intravascular connector with a 5-second alcohol scrub. Infect Control Hosp Epidemiol 2012;33:661665.CrossRefGoogle ScholarPubMed
24. 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;40:931934.CrossRefGoogle Scholar
25. See, I, Iwamoto, M, Allen-Bridson, K, Horan, T, Magill, SS, Thompson, ND. Mucosal barrier injury laboratory-confirmed bloodstream infection: results from a field test of a new National Healthcare Safety Network definition. Infect Control Hosp Epidemiol 2013;34:769776.CrossRefGoogle ScholarPubMed
29
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Use of Disinfection Cap to Reduce Central-Line–Associated Bloodstream Infection and Blood Culture Contamination Among Hematology–Oncology Patients
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Use of Disinfection Cap to Reduce Central-Line–Associated Bloodstream Infection and Blood Culture Contamination Among Hematology–Oncology Patients
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Use of Disinfection Cap to Reduce Central-Line–Associated Bloodstream Infection and Blood Culture Contamination Among Hematology–Oncology Patients
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *