Disinfecting Port Protectors: A Case Study
Do disinfecting port protectors help prevent central and peripheral line associated bloodstream infection? The purpose for this evidence based research paper is to determine whether that the use of disinfecting port protectors (green/red caps) reduces the incidence of intravenous catheter related bloodstream infection in the hospital setting. In our clinical rotation, we noticed that some nurses implemented the usage of the disinfecting port protectors to prevent infection, while others did not. Studies show that consistent use of Curos disinfecting caps on IV needleless connectors is associated with decreased central line associated bloodstream infection (CLABSI). In 2014, an estimated 250,000 people in the United States were affected by catheter related bloodstream infections (DeVries, 2014). Many hospitals have started to implement the usage of these devices in the past 5 years. Our goal with this research project is to find out if these disinfecting port protectors really help in the fight against infection-causing microorganisms. Majority of the patients will have at least one IV line inserted during their hospital stay. When nursing staff fail to care and maintain the IV port properly, it increases the patient’s risk for bloodborne infection. According to British Journal Of Cardiac Nursing, “Infection can occur from endogenous means where
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organisms are already present in the body or through exogenous means where organisms enter the body from cross-infection” (Campbell & Bowden, 2011). The journal also indicated “Insertion of a VAD involves entering the circulatory system directly, which creates the risk of infection by breaching the body’s natural barriers. It is therefore critical to apply the principles of aseptic non-touch technique (ANTT) when inserting and accessing peripheral IV devices” (Campbell & Bowden, 2011). Dr. Parks from 3M Critical and Chronic Care Solutions indicated that “BSIs have two main sources, the patient’s skin at the insertion site and the IV catheter access port” (Cantrell, 2017). Parks also explained that “to protect the catheter line, the 3M Curos Disinfecting Port Protectors reduce microbial risk for up to 7 days, at every access point, while the passive disinfection design and bright green color support compliance by eliminating human error from scrub-the-hub techniques, allowing nurses to verify that the port is clean at a glance. Convenience is an attribute as well.” (Cantrell, 2017). Since microorganism can easily grow from the needleless catheter access port when is contaminated, it is essential to prevent any cross contamination on the access port. The disinfecting port protector is one of the key prevention methods to prevent the access port from contaminated. Many studies have conducted for the effectiveness of the disinfecting port protectors. Our first article was conducted in 2011 in a community hospital setting consisting of over 400 beds. In December 2011, this facility started using disinfecting cap technology and tracked compliance as well as infection rates. “Comparing the 7 months prior to implementation with the 7 months following implementation, the CLABSI rate in ICUs decreased from 1.61 to 0.90 per 1000 catheter days (44.1% reduction) and in non-ICU units from 0.94 to 0.64 per 1000 catheter days (31.9% reduction). One unit that consistently maintained 100% compliance sustained a rate of zero infections” (Seller, 2013). This study shows that in this facility, the use of port protectors as well as supplemental flush technology really helps to reduce or even eliminate the chance of bloodstream infection. A second study implemented at Methodist Hospitals derived from a practice audit that revealed deficiencies in manual disinfection of intravenous catheters, increasing the risk for bloodstream infections. The hospital then got the nurses involved and put to trial 2 new devices (alcohol-impregnated disinfection caps and a friction-scrubbing device) in which they would try and choose one for use in the intensive care unit. The nurses chose the caps. After 3 months, no bloodstream infections occurred. These results influenced the team to start using the disinfectant caps throughout the entire hospital, not only on central venous catheters, but on peripherally inserted central catheters (PICC), and peripheral lines as well. With the use of these caps, the bloodstream infection rate dropped 43% for peripheral lines, 50% for central lines, and 45% overall (DeVries, 2014). Again, study data strongly support the effectiveness of using disinfecting port protectors for bloodborne infection prevention. Another study, based in England in 2014, was implemented because of increasing healthcare associated infections (HAIs). Disinfection wipes used for needleless devices were replaced by Curos disinfecting caps for 6 months in 4 different units (oncology, acute care, ICU, and surgical) at a local British hospital. The infection control team at this hospital wanted to replace the active “hub-scrubbing” technique with an aseptic non-touch technique in hope of decreasing the chance of infection. “The trial period showed CRBSI rates drop 69% from 26 cases to 8, when staff compliance reached 80% or more” (Cameron-Watson, 2016). In addition to a drop in infection rates, nurses became more compliant with aseptic technique, saved time on their shifts since they were not scrubbing hubs, and the cost of healthcare and treatments dropped due to the decrease in bloodstream infection. After all the evidence based research results from the articles we looked at, it is clear that disinfecting port protectors do indeed prevent hospital bloodborne infection. Our plan is to further investigate the effectiveness of disinfecting port protectors in a real hospital setting during our preceptorship. In average, there will be 3 to 5 nurses working in a unit each shift to care for the patients; and each nurse will be responsible to care for 3 to 5 patients; and each patient probably will be staying in the hospital for 4 days. Based on these numbers, we decide to use the target number of 1460 patients (4 nurses X 4 patients X [365/4 days of hospital stay] = 1460) as our investigation number. We will try to gather infection records from the nurses that actually use the disinfecting port protectors and compare it to the nurses that do not use this prevention method and see how many cases of bloodborne infection occur during the entire year. It might be hard for us as students to have access to those infection records; however we are hoping that staff and instructors will assist us in getting that information to help us prove the effectiveness of the disinfecting caps further. As a student nurse, we did not have the access to the infection record from Kaiser, the only information we have is 2 out of 5 nurses will use the disinfecting port protectors when care for patients with IV line. The other nurses will implement the usage of disinfecting rubbing method. Basic on the lack of actual documentation, we did not know how effective is the method of using disinfecting port protectors to prevent bloodborne infection. However, we did found information regarding the infection rate in the Kaiser Vallejo ICU unit based on Leapfrog Hospital Survey. According to the source, there are 0 case of infection in the blood during ICU stay during the physical year of 2016. (The Leapfrog Group, 2016). In addition to our evidence based researches study, this resource helps us conclude the effectiveness of the disinfecting port protectors indeed can prevent bloodborne infection in the hospital setting. In conclusion, it is the responsibility of the nurse staff to care and protect the patient from acquires bloodborne infection during their hospital stay.
When a patient developed infection, the length of the hospital stay is extended, and the cost of hospital cost will increase. The purpose of disinfecting port protectors is to prevent patient from acquire bloodborne infection and evident based research has been proven its effectiveness. By using disinfecting port protectors in patient with IV port, not only nurses can help to protect the patient, they can also help the hospital to save a large amount of
revenues.
organisms are already present in the body or through exogenous means where organisms enter the body from cross-infection” (Campbell & Bowden, 2011). The journal also indicated “Insertion of a VAD involves entering the circulatory system directly, which creates the risk of infection by breaching the body’s natural barriers. It is therefore critical to apply the principles of aseptic non-touch technique (ANTT) when inserting and accessing peripheral IV devices” (Campbell & Bowden, 2011). Dr. Parks from 3M Critical and Chronic Care Solutions indicated that “BSIs have two main sources, the patient’s skin at the insertion site and the IV catheter access port” (Cantrell, 2017). Parks also explained that “to protect the catheter line, the 3M Curos Disinfecting Port Protectors reduce microbial risk for up to 7 days, at every access point, while the passive disinfection design and bright green color support compliance by eliminating human error from scrub-the-hub techniques, allowing nurses to verify that the port is clean at a glance. Convenience is an attribute as well.” (Cantrell, 2017). Since microorganism can easily grow from the needleless catheter access port when is contaminated, it is essential to prevent any cross contamination on the access port. The disinfecting port protector is one of the key prevention methods to prevent the access port from contaminated. Many studies have conducted for the effectiveness of the disinfecting port protectors. Our first article was conducted in 2011 in a community hospital setting consisting of over 400 beds. In December 2011, this facility started using disinfecting cap technology and tracked compliance as well as infection rates. “Comparing the 7 months prior to implementation with the 7 months following implementation, the CLABSI rate in ICUs decreased from 1.61 to 0.90 per 1000 catheter days (44.1% reduction) and in non-ICU units from 0.94 to 0.64 per 1000 catheter days (31.9% reduction). One unit that consistently maintained 100% compliance sustained a rate of zero infections” (Seller, 2013). This study shows that in this facility, the use of port protectors as well as supplemental flush technology really helps to reduce or even eliminate the chance of bloodstream infection. A second study implemented at Methodist Hospitals derived from a practice audit that revealed deficiencies in manual disinfection of intravenous catheters, increasing the risk for bloodstream infections. The hospital then got the nurses involved and put to trial 2 new devices (alcohol-impregnated disinfection caps and a friction-scrubbing device) in which they would try and choose one for use in the intensive care unit. The nurses chose the caps. After 3 months, no bloodstream infections occurred. These results influenced the team to start using the disinfectant caps throughout the entire hospital, not only on central venous catheters, but on peripherally inserted central catheters (PICC), and peripheral lines as well. With the use of these caps, the bloodstream infection rate dropped 43% for peripheral lines, 50% for central lines, and 45% overall (DeVries, 2014). Again, study data strongly support the effectiveness of using disinfecting port protectors for bloodborne infection prevention. Another study, based in England in 2014, was implemented because of increasing healthcare associated infections (HAIs). Disinfection wipes used for needleless devices were replaced by Curos disinfecting caps for 6 months in 4 different units (oncology, acute care, ICU, and surgical) at a local British hospital. The infection control team at this hospital wanted to replace the active “hub-scrubbing” technique with an aseptic non-touch technique in hope of decreasing the chance of infection. “The trial period showed CRBSI rates drop 69% from 26 cases to 8, when staff compliance reached 80% or more” (Cameron-Watson, 2016). In addition to a drop in infection rates, nurses became more compliant with aseptic technique, saved time on their shifts since they were not scrubbing hubs, and the cost of healthcare and treatments dropped due to the decrease in bloodstream infection. After all the evidence based research results from the articles we looked at, it is clear that disinfecting port protectors do indeed prevent hospital bloodborne infection. Our plan is to further investigate the effectiveness of disinfecting port protectors in a real hospital setting during our preceptorship. In average, there will be 3 to 5 nurses working in a unit each shift to care for the patients; and each nurse will be responsible to care for 3 to 5 patients; and each patient probably will be staying in the hospital for 4 days. Based on these numbers, we decide to use the target number of 1460 patients (4 nurses X 4 patients X [365/4 days of hospital stay] = 1460) as our investigation number. We will try to gather infection records from the nurses that actually use the disinfecting port protectors and compare it to the nurses that do not use this prevention method and see how many cases of bloodborne infection occur during the entire year. It might be hard for us as students to have access to those infection records; however we are hoping that staff and instructors will assist us in getting that information to help us prove the effectiveness of the disinfecting caps further. As a student nurse, we did not have the access to the infection record from Kaiser, the only information we have is 2 out of 5 nurses will use the disinfecting port protectors when care for patients with IV line. The other nurses will implement the usage of disinfecting rubbing method. Basic on the lack of actual documentation, we did not know how effective is the method of using disinfecting port protectors to prevent bloodborne infection. However, we did found information regarding the infection rate in the Kaiser Vallejo ICU unit based on Leapfrog Hospital Survey. According to the source, there are 0 case of infection in the blood during ICU stay during the physical year of 2016. (The Leapfrog Group, 2016). In addition to our evidence based researches study, this resource helps us conclude the effectiveness of the disinfecting port protectors indeed can prevent bloodborne infection in the hospital setting. In conclusion, it is the responsibility of the nurse staff to care and protect the patient from acquires bloodborne infection during their hospital stay.
When a patient developed infection, the length of the hospital stay is extended, and the cost of hospital cost will increase. The purpose of disinfecting port protectors is to prevent patient from acquire bloodborne infection and evident based research has been proven its effectiveness. By using disinfecting port protectors in patient with IV port, not only nurses can help to protect the patient, they can also help the hospital to save a large amount of
revenues.