None listed
Conditions
Brief summary
The large number of patients require a central venous access device (CVAD) for the administration of intravenous fluids, medications, blood products and specialised treatments. These intravenous fluid lines will be accessed by nurses via a needleless connector (NC) multiple times every shift; however these connectors have also been linked with the development of CVAD associated bloodstream infection (CLABSI). The two most common causes of CLABSI are: the colonisation of the outer surface of the catheter during insertion from bacteria originating from the skin; and colonisation of the inner surface of the catheter through contamination of the hub or NC, often from poor non-touch technique practices from healthcare workers. These complications can be minimised, however while practice is variable, with little evidence to guide clinicians, research is required to reduce the gaps in this area. The importance of decontaminating the needleless connectors (NC) has been highlighted prior to accessing the central venous access device (CVAD) by many of the current CVAD guidelines. However, the standard for the scrub time and the decontamination solution is still lacking, with some studies showing the time required for decontamination to be from 10 to 30 seconds using friction and 70% isopropyl alcohol swab. The Centre for Disease Control and Prevention (CDC) guidelines for the prevention of intravascular catheter-related infections suggest decontamination with a chlorhexidine/alcohol preparation. However, they do not mention a specific time for this procedure, other than stating that using a 70% alcohol solution for 3 to 5 seconds is not adequate (O'Grady, 2011). The national evidence based guidelines for preventing healthcare associated infections in National Health Service hospitals in England (Epic3) recommend disinfecting the connector for a minimum of 15 seconds with chlorhexidine gluconate in 70% isopropyl alcohol, then allowing it to dry prior to accessing the system. The Queensland Health I-Care Guideline for Tunnelled Central Venous Catheters recommends a 5 second scrub with a 70% alcohol solution and allowing the connector to dry before accessing the CVAD system. With each guideline having differing recommendations, clinicians may have difficulty deciding which method will reduce the risk of CLABSI.
Interventions
Intervention 1: Decontamination of the needleless connector using a 2% chlorhexidine and 70% alcohol swab
Intervention 2: Decontamination of the needleless connector with the use of a 70% alcohol impregnated cap that is screwed into place on the needleless connector, and remains in place until nursing staff are required to inject medications into the connector. The cap is discarded, and a new one applied once treatment has been completed. The cap can stay in position for up to one week, and is
Intervention 1: Decontamination of the needleless connector using a 2% chlorhexidine and 70% alcohol swab Intervention 2: Decontamination of the needleless connector with the use of a 70% alcohol impregnated cap that is screwed into place on the needleless connector, and remains in place until nursing staff are required to inject medications into the connector. The cap is discarded, and a new one applied once treatment has been completed. The cap can stay in position for up to one week, and is required to be in position for at least 5 minutes prior to decontamination taking effect. Overall duration of the intervention will be from device insertion through to device removal, or up to 4 weeks from time of recruitment (whichever comes first). The frequency of decontamination will be each time the connector is accessed. Ward nursing staff will be administering the intervention. Adherence to the intervention will be monitored by a Research nurse twice weekly to assess compliance.
Sponsors
Griffith University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients greater than or equal to 18 years of age Requiring a CVAD to be inserted for greater than or equal to seven days Able to provide informed consent CVAD inserted within 24 hours of recruitment
Exclusion criteria
Non-English speaking without an interpreter Current bloodstream infection Previous enrolment in the study in current hospital admission
Outcome results
None listed