TY - JOUR
T1 - Alcohol-impregnated caps and ambulatory central-line-associated bloodstream infections (CLABSIs)
T2 - A randomized clinical trial
AU - Milstone, Aaron M.
AU - Rosenberg, Carol
AU - Yenokyan, Gayane
AU - Koontz, Danielle W.
AU - Miller, Marlene R.
N1 - Funding Information:
This project was supported by the Agency for Healthcare Research and Quality (grant no. R01HS022870). The commercial sponsor (3M, St. Paul, MN) provided in-kind product but had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Funding Information:
A.M.M. received prior grant support from Sage Products, and received consulting fees for Becton Dickinson both unrelated to this work, and he receives grant support from NIH, CDC, and AHRQ unrelated to this work. J.G.C. is a member of the CDC Healthcare Infection Control Practice Advisory Committee (HICPAC). All authors report no conflicts of interest relevant to this article.
Publisher Copyright:
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Objective: To evaluate the effect of 70% isopropyl alcohol-impregnated central venous catheter caps on ambulatory central-line-associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients. Design: This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial. Setting: The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics. Participants: All patients with an external central line followed at 1 of the 16 hematology-oncology clinics. Intervention: Usual ambulatory central-line care per each institution using 70% isopropyl alcohol-impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol-impregnated caps. Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63-1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52-0.99). No adverse events were reported. Conclusions: Isopropyl alcohol-impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol-impregnated caps in the ambulatory setting.
AB - Objective: To evaluate the effect of 70% isopropyl alcohol-impregnated central venous catheter caps on ambulatory central-line-associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients. Design: This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial. Setting: The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics. Participants: All patients with an external central line followed at 1 of the 16 hematology-oncology clinics. Intervention: Usual ambulatory central-line care per each institution using 70% isopropyl alcohol-impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol-impregnated caps. Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63-1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52-0.99). No adverse events were reported. Conclusions: Isopropyl alcohol-impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol-impregnated caps in the ambulatory setting.
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U2 - 10.1017/ice.2020.467
DO - 10.1017/ice.2020.467
M3 - Article
C2 - 33040755
AN - SCOPUS:85093948212
SN - 0899-823X
VL - 42
SP - 431
EP - 439
JO - Infection control and hospital epidemiology
JF - Infection control and hospital epidemiology
IS - 4
ER -