Kamboj, M., Blair, R., Bell, N., Son, C., Huang, Y.T., Dowling, M., . . . Sepkowitz, K. (2015). Use of disinfection cap to reduce central-line–associated bloodstream infection and blood culture contamination among hematology-oncology patients. Infection Control and Hospital Epidemiology, 36, 1401–1408. 

To evaluate the impact of the routine use of a passive disinfection cap for catheter hub decontamination

Prior to the use of disinfection caps, the organization followed Centers for Disease Control and Prevention (CDC) recommendations for catheter care and routinely used chlorhexidine-impregnated dressings. The intervention was the routine use of disinfection caps with each central venous catheter (CVC) access rather than manual scrubbing of catheter hubs. The caps were changed after each access or every seven days on high-risk units. After implementation on high-risk units for six months, disinfection caps were introduced for routine use in general oncology units. Central line–associated bloodstream infection (CLABSI) rates were compared across all phases, preimplementation to full implementation. Data were compared to that from clinical units that did not use disinfection caps.

• N = 691 patients with 806 CLABSI episodes. Total patients with central lines was not reported.
• AGE = Not provided
• MALES: Not provided, FEMALES: Not provided
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Not provided
• OTHER KEY SAMPLE CHARACTERISTICS: Not provided

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: New York

• Prospective observational

• Device utilization ratio—number of catheter days to patient days
• Standardized incidence ratio—ratio of observed infections to expected number of infections, assuming incidence rates were the same as those for the reference period

No significant decrease in CLABSI rates occurred when disinfection caps were used in high-risk units. CLABSI rates declined significantly when the caps were introduced among general oncology units that were at high-risk (p < 0.001); however, CLABSI rates did not change significantly within general oncology units that were not high-risk. The proportion of contaminated blood cultures from high-risk units declined after introducing the disinfection caps (p < 0.01). Substantial cost savings with reduction in CLABSI rates and contaminated specimens was estimated, assuming hospitalwide implementation results.

The use of catheter disinfection caps may help reduce CLABSI rates in high-risk patient groups and reduce the contamination of blood culture specimens obtained via catheters.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (sample characteristics)
• Unintended interventions or applicable interventions not described that would influence results
• Key sample group differences that could influence results
• No patient demographic information was provided, and whether patients were being actively treated in all areas was uknown; high-risk units included general medical-surgical intensive care, not oncology-specific populations
• No information was provided on other relevant practices, such as antibiotic prophylaxis.
• Whether all catheters were long-term indwelling catheters is unclear, particularly because general intensive care units were included.
• No information regarding other factors that could influence results
• Cost reduction estimates assumed hospitalwide implementation of disinfection caps; why this was done is unclear, because changes in CLABSI rates were seen only on high-risk units.

The findings suggest that the routine use of disinfection caps for CVCs may be helpful in reducing CLABSI rates among patients undergoing hematopoietic cell transplantation (HCT) and those with hematologic malignancies deemed to be at high-risk for infection. This is a relatively low-cost intervention that may be beneficial; however, this study does not provide strong evidence in support of this effect. Given the findings here, further research on the effects of this approach is warranted.