Disinfection Practices: Recommendations to Reduce Hospital-Acquired Infection Rates
Central line associated bloodstream infections (CLABSIs) can result in significant morbidity and mortality. The Agency for Healthcare Research and Quality (AHRQ) estimates that 28,000 patients die from CLABSI each year in the United States 1. Hospital-acquired infections are nearly preventable with strict adherence to aseptic techniques. What are some of the recommendations for disinfection practices to reduce CLABSI rates?
Disinfect Needleless Connectors
Alcoholic chlorhexidine, 70 percent alcohol, povidone iodine, or some other appropriate antiseptic cleaning agents should be used on needleless connectors, IV access ports, and stopcocks immediately before connection, infusion, or aspiration 2.
Ensure Hand Hygiene
Common risk factors for healthcare-associated infections should be assessed. Simple measures to improve compliance with hand hygiene can significantly reduce bloodstream infections. The World Health Organization (WHO) offers several tools and resources to help achieve changes in hand hygiene as part of a multi-modal strategy 3.
Educate Healthcare Personnel
Healthcare personnel should be educated about the proper procedures for insertion and maintenance of intravascular catheters. Knowledge should be continually assessed with periodic surveillance. Only trained personnel should be designated to insert and maintain peripheral and central lines 4.
Use Passive Continuous Hub Disinfection
Antimicrobial caps and disinfecting port protectors provide continuous passive disinfection of the hub for several days. These devices should be used according to the manufacturer’s instructions and in conjunction with frictional aseptic techniques before access 2.
Evaluate New Technology with a Formal Process
The design of intravenous needleless connectors and other new technologies play a significant role in reducing the risk of catheter-related bloodstream infections. For example, more complicated fluid pathways of certain needleless connectors can create surfaces that promote biofilm formation. A split septum design can permit a straight path for the fluid which can minimize the surface area for biofilm formation 5.
Several new technologies are available to help prevent catheter infections. These include antiseptic-coated catheters, disinfecting caps, and closed medication delivery systems. Closed care IV systems can effectively reduce touch contamination and the number of connections and disconnections performed by care providers.