Sweet, M.A., Cumpston, A., Briggs, F., Craig, M., & Hamadani, M. (2012). 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. American Journal of Infection Control, 40, 931–934.

The objective of this study was to assess the effect of optimizing hub disinfection using alcohol-impregnated port protectors by measuring the rate of central line-associated bloodstream infections (CLABSIs) and contaminated blood cultures (CBCs) in adult oncologic patient population.

The intervention involved switching traditional catheter hub care using alcohol wipes to care using 70% isopropyl alcohol-impregnated port protectors and needless neutral-pressure connectors. The intervention period results were compared to those from historical controls. Data were collected for all types of central lines, including peripherally inserted tunneled catheters and implanted ports. Line insertion techniques followed best practices for draping, skin prep, etc. Port protectors are luer lock-style caps with provide cleaning as they are twisted on and off catheter hubs. A new protector is used each time the port is accessed. Compliance was assessed by weekly observations defined as percentage of patients with catheter protectors in place.

• The sample size was 1,272.
• The age range of participants was 19–92.
• Women made up 51% of the sample; men made up 49%.
• Key disease characteristics were blood and solid cancers.

A single-site inpatient setting in West Virginia

Active antitumor treatment

Observational trial with comparison to historical controls

Observational comparison. Researchers compared CLABSI and CBC rates before and after intervention.

There was a statistically significant decrease in CLABSI rates with the use of alcohol-impregnated port protectors  from 2.3 per 1,000 central line days to 0.3 per 1,000 central line days during the intervention period (RR = 0.14, 95% CI [0.02, 1.07], p = 0.03). The rate of contaminated blood cultures decreased from 2.5% to 0.2% (RR = 0.09, 95% CI [0.01, 0.65], p = 0.002).

The use of alcohol-impregnated port protectors may help to reduce CLABSI rates. Further evidence is needed to make strong conclusions.

• Baseline sample/group differences of import   
• Risk of bias (no control group) 
• 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
• There is too much unexplained variability in this study to draw firm conclusions– types of disease and associated risk of infections are not described. 
• Varied types of catheters are included and considered together, although these are associated themselves with different risk of infection. 
• There is no information about total catheter dwell time, and whether these differed. 
• Although specific CLABSI rates may have differed, there is no information or analysis as to whether the rate of catheter removal and change differed. 
• Method of determination of compliance with specifics of use and hub changes is questionable–the fact that a hub is observed to be in place in a single point observation does not say anything about whether or not that is being changed as required for each hub access.

Suboptimal hub disinfection has a great effect on CLABSI rates. The use of alcohol-impregnated port protectors could help prevent CLABSI by eliminating this factor from the equation; however, effect sizes shown here are small. There are numerous limits to the evidence provided here which reduces the strength of the evidence and any conclusions that can be drawn; however, findings are promising. Additional well-designed studies are warranted. It would be useful to have associated cost benefit analysis, and studies comparing this approach to others to determine most cost-effective approaches to reduce CLABSI risk and rates.