Methods for microbial needleless connector decontamination: A systematic review and meta-analysis

Abstract

Background: The objective of this review was to compare the effectiveness of connector decontamination with 70% alcohol wipes, alcoholic chlorhexidine gluconate wipes, or alcohol impregnated caps to prevent catheter-associated bloodstream infection (CABSI). Methods: A systematic search was conducted in CINAHL, Cochrane Central Register of Controlled Trials, Medline, and PubMed. The primary outcome was CABSI, with randomized and observational studies included. The inclusion criteria were: English language, any age group, no date limitations, and reporting connector decontamination interventions to prevent CABSI. The exclusion criteria were: multimodal interventions, letters, and conference abstracts. Quality assessment with the Newcastle-Ottawa Scale, a narrative synthesis, and metaanalysis were conducted. Pooled data used a random effects model for pair-wise comparisons, due to clinical heterogeneity. Statistical heterogeneity was investigated by visual model inspection, x 2 , and I 2 statistics. Results: Ten studies compared 70% alcohol wipes with 70% alcohol-impregnated caps, and 2 studies (n = 1,216) tested an alcoholic chlorhexidine gluconate wipe. Alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.28; 95% confidence interval, 0.20-0.39). Alcohol-impregnated caps were associated with significantly less CABSI than 70% alcohol wipes (risk ratio, 0.43; 95% confidence interval, 0.28-0.65). Studies were of low to moderate quality. Conclusions: Alcohol impregnated caps and alcoholic chlorhexidine gluconate wipes were associated with significantly less CABSI than 70% alcohol wipes. This requires confirmation in randomized controlled trials.

Efecto del uso de protectores puerto desinfectantes para la disminución de las bacteriemias asociadas a catéteres venosos centrales

“…Finalmente, Flynn et al 22 concluyeron que estudios no randomizados evidencian que tanto las toallitas con clorhexidina alcohólica como la desinfección pasiva con tapones impregnados con AIP al 70% se asocian con una incidencia de BACVC significativamente más baja que las toallitas con AIP al 70% (IRR,0.43; IC 95%, 0.28-0.65). Sin embargo, resaltan que existe una falta de evidencia de alta calidad para confirmar cuál es el mejor método de desinfección al colocar y mantener un dispositivo de acceso vascular.…”

“…Flynn et al 22 identificaron que la desinfección activa de los CSA con toallitas de clorhexidina alcohólica o la desinfección pasiva de los mismos con tapones impregnados de AIP al 70%, se asocia con una disminución significativa en el riesgo de desarrollar una BACVC; en comparación con el uso de toallitas con AIP al 70%. En el desarrollo del meta-análisis, se asoció, con una estimación muy precisa del efecto, que el uso de toallitas con clorhexidina alcohólica; en comparación con las toallitas con AIP al 70% se asocia con dos tercios menos de riesgo de desarrollar una BACVC (IRR, 0.28; 95% IC, 0.20-0.39).…”

“…No obstante, los autores aclaran que, a pesar de que los resultados del meta-análisis fueron positivos, es necesario que se realicen ensayos clínicos aleatorizados con un tamaño de muestra suficientemente grande para confirmar la causalidad. Asimismo, aunque el uso de la clorhexidina como agente desinfectante para los CSA se ha incrementado debido a estudios que han concluido que su uso es superior al alcohol en la prevención de infecciones y que tiene una actividad de descontaminación prolongada, recalcan que no existe evidencia suficiente de que esto resulte en menos BACVC 22 .…”

Response to the Letter to the Editor regarding “Methods for microbial needleless connector decontamination: A systematic review and meta-analysis”

“…Sink drainage systems are a potential reservoir for spread of multidrug-resistant gram-negative bacilli. 1 Pouring liquid disinfectants into sink drains has only a transient impact on sink colonization. 1,2 The efficacy of pouring disinfectants may be suboptimal in part because liquid disinfectants flow rapidly down the drain, providing minimal contact time and poor penetration into areas harboring microorganisms.…”

“…We wish to thank Gl el e et al for their interest in our article, "Methods for microbial needleless connector decontamination: A systematic review and meta-analysis" by Flynn et al 1 We hope that this is a demonstration of a growing interest in needleless connector decontamination and will help increase the quality and quantity of research on the topic.…”