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PICO Question
In hospitalized ICU patients (P), does the use of chlorhexidine caps (I) have a lower infection rate (O) compared to those that do not use chlorhexidine caps (C) on central lines ports?
Plan
I plan to test the efficacy of the chlorhexidine disinfectant cap in ICU patients
I hope that the use of chlorhexidine caps on the ports of the central lines will reduce the infection rate of hospitalized ICU patients.
Hospitalized patients in the intensive care unit often require a central venous catheter (CVC). Tejada et al. (2022) note that CVC placement provides reliable vascular access when fluids, drugs, and nutrients are needed but may increase the risk of central line-associated bloodstream infection. CLABSIs are one of the most common causes of morbidity and mortality in hospitalized patients in the intensive care unit (Gillis et al., 2022). The incidence of CLABSI depends on many modifiable and non-modifiable factors, including optimal catheter care and the use of antiseptics. One option is a chlorhexidine antiseptic barrier cap that provides passive and continuous disinfection of the catheter hub without the need for manual cleaning. Zamir et al. (2020) claim that its use saves time and reduces the incidence of bacterial contamination of the catheter hub. According to Person et al. (2022), introducing these devices into routine catheter care in intensive care units may be associated with reduced CLABSI incidences.
Do
To determine the effectiveness of chlorhexidine caps among hospitalized patients in the intensive care unit, the incidence of hospital-acquired CLABSI was studied before and after the introduction of this practice.
Before introducing chlorhexidine caps, the frequency of (HA)-CLABSI was studied based on adherence to CDC recommendations for catheter care. These methods included hand hygiene, alcohol disinfection by wiping the sleeve with an alcohol wipe before access, catheter access with a sterile device only, changing dressings that were visibly wet, soiled, or dislodged, and changing dressings using an aseptic technique.
The second phase of the study consisted in studying the frequency of (HA)-CLABSI after the installation of disinfection caps on the central lines ports. Chlorhexidine caps were introduced after training the medical staff on the correct use of the device.
The duration of each phase was limited to 3 months.
Study
In determining the frequency of (HA)-CLABSI, primary CLABSI was determined according to CDC/National Healthcare Safety Network (NHSN) criteria. The onset of bacteremia >48 hours after hospital admission was used to classify infections as nosocomial (HA). It was found that after administration with chlorhexidine at the ports of the central lines, the frequency of HA-CLABSI among hospitalized patients in the intensive care unit was significantly reduced.
Moreover, a cost analysis was conducted to determine the financial implications of introducing disinfectant caps. Costs reflect the actual hospital costs for caps as well as for HA-CLABSI patient care.
Act
As a result of the introduction of chlorhexidine caps, there has been an overall decrease in CLABSI incidences across the intensive care unit by 35%. Furthermore, about $3 million in cost savings are associated with using CVC chlorhexidine caps. The clinical consequences of CLABSI are significant. Treatment can prolong hospital stay and lead to readmissions, overuse of antibiotics, and a substantial increase in professional time spent on managing patients treated for contaminants. Thus, additional savings can be achieved by using a chlorhexidine cap.
Thus, using CVC caps with chlorhexidine is a practical and inexpensive method of catheter care. This method effectively reduces HA-CLABSI levels among hospitalized patients in the intensive care unit. Because of the improved clinical outcomes and significant cost savings associated with the use of CVC chlorhexidine caps, the routine use of this device in clinical practice is recommended.
References
Gillis, V. E., van Es, M. J., Wouters, Y., & Wanten, G. J. (2022). Antiseptic barrier caps to prevent central line-associated bloodstream infections: A systematic review and meta-analysis. American Journal of Infection Control. Web.
Person, M. E., Biggs, J., & Ross, E. (2022). Central line associated bloodstream infection prevention with use of disinfection caps: A scoping review. Doctor of Nursing Practice Projects, 16. Web.
Tejada, S., Leal-dos-Santos, M., Peña-López, Y., Blot, S., Alp, E., & Rello, J. (2022). Antiseptic barrier caps in central line-associated bloodstream infections: A systematic review and meta-analysis. European Journal of Internal Medicine, 99, 70-81. Web.
Zamir, N., Pook, M., McDonald, E., & Fox-Robichaud, A. E. (2020). Chlorhexidine locking device for central line infection prevention in ICU patients: Protocol for an open-label pilot and feasibility randomized controlled trial. Pilot and Feasibility Studies, 6, 1-10. Web.
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