Alcohol Impregnated Caps: Are They Effective for Preventing Clabsi?

BACKGROUND: Approximately 41,000 central line-associated blood stream infections (CLABSI) occur in U.S. hospitals annually with an estimated mortality rate of 12 - 25% and annual cost estimates of $2.3 – 28 billion. Immunocompromised bone marrow transplant (BMT) patients pose an increased risk for CLABSI acquisition. Central venous catheter (CVC) hub contamination is a known risk factor for CLABSI. Curos® alcohol impregnated port protectors have been shown to reduce CLABI in several patient populations. METHODS: An Institutional Review Board for Human Use approved observational study was conducted on a 16 bed BMT unit at a tertiary hospital. All BMT patients admitted with a new CVC or an existing CVC with negative blood cultures were invited to participate. During a six month intervention period, staff performed best practice by scrubbing the MicroCLAVE® neutral pressure hubs with alcohol and used Curos® caps for passive disinfection on all line ports. The intervention period December 2011 - June 2012 was compared to the historical control period June 2011 - November 2011. Rounds were performed to monitor staff compliance with cap usage. RESULTS: Twenty-one BMT patients participated in the study. Three of the twenty-one patients acquired CLABSI. During the intervention phase, CLABSI occurrence was 4 infections / 847 device days. During the historical control period CLASBSI occurrence was 4 infections / 830 device days. Staff compliance with Curos® cap usage was 95%.  Patient’s perceptions of line care were improved. CONCLUSION: The CLABSI rate on this BMT unit did not improve with the Curos® alcohol impregnated cap added to the CVC best practice bundle. Sustained, ongoing multidisciplinary involvement evaluating each aspect of the CLABSI bundle should be further evaluated in effort to reduce BMT CLABSI rate.