Using isopropyl alcohol impregnated disinfection caps in the neonatal intensive care unit can cause isopropyl alcohol toxicity

Sauron, Charlotte; Jouvet, Philippe; Pinard, Geneviève; Goudreault, Danielle; Martin, Brigitte; Rival, Bastien; Moussa, Ahmed

doi:10.1111/apa.13099

Cited by 13 publications

(22 citation statements)

References 13 publications

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“…The main result of this in vitro study is that we can confirm the results from Sauron et al that there is a risk of IPA leakage when IPA caps are used [ 9 ]. This is troublesome as alcohol caps have been shown to be effective and are considered to be an important tool against catheter-associated infections [ 5 – 8 ].…”

Section: Discussionsupporting

confidence: 81%

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Leakage of isopropanol from port protectors used in neonatal care—Results from an in vitro study

et al. 2020

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Background To decrease contamination of needleless catheter hubs, caps or port protectors impregnated with isopropanol (IPA) have been developed and shown to be superior to other disinfection methods. The safety of the caps has been questioned, as they can be associated with alcohol leakage across the hub membrane. Objectives We evaluated the use of IPA caps and the scrub-the-hub method from the safety standpoint of possible alcohol leakage across the hub membrane. Methods Circuits imitating an intravenous line were constructed. Circuits with an IPA cap were flushed with sodium chloride after the hub had been exposed to the cap for 1 hour, 24 hours, and 7 days. At the end of each period the fluid was collected and amounts of IPA in it were measured, using gas chromatography. Scrub circuits without IPA caps were also tested and ethanol from these was measured using the same method. Results In this in vitro study, IPA was detected in all samples from cap circuits, and ethanol was detected from all scrub circuits. Leakage increased over time in IPA circuits. After 24 hours and 7 days of exposure, the first injection resulted in higher amounts of IPA; thereafter, the levels decreased. The amounts of ethanol measured from the scrub circuits were low. Conclusions IPA caps can cause leakage of alcohol across the hub membrane. Leakage increased over time, and a 30 sec drying time was not sufficient to solve the problem. Scrub-the-hub seems safe to use with regard to alcohol leakage.

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Section: Discussionsupporting

confidence: 81%

“…Based on the previously mentioned study [ 9 ] we decided to test two commercially available alcohol caps together with two hubs commonly used in neonatal intensive care in order to evaluate potential leakage from alcohol caps. For comparison we also evaluated the leakage of alcohol from the scrub-the-hub method.…”

Section: Introductionmentioning

confidence: 99%

Leakage of isopropanol from port protectors used in neonatal care—Results from an in vitro study

et al. 2020

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“…Routine use of disinfection caps among adult high‐risk hematology oncology patients proved a reduction in both hospital‐acquired CLABSI and blood culture contamination, 34% and 63%, respectively 62 . Sauron et al 63 caution of its use in the neonatal population as laboratory testing of SwabCap (Excelsior Medical, LLC, Neptune, NJ), 1 brand of IPA‐impregnated disinfection cap, after a 96‐hour contact with SmartSite or CareSite valves, compromised the valves' appearance. Although toxic plasmatic levels are unknown, based on calculated assumptions of tolerated levels, the IPA levels were almost doubled.…”

Section: Prevention Strategies—disinfection Capsmentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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“…Auf die Gefahr des Bakterieneintrags durch die Membranen der NFC bei ausbleibender Desinfektion vor Verwendung wird explizit hingewiesen. Von Isopropanol-freisetzenden Verschlusskappen auf NFCs wird abgeraten, weil sie die Integrität von NFCs beeinträchtigen können und es bei Injektionen über das NFC zu einem Eintrag von Isopropylalkohol in die Blutbahn kommen kann [15]. Erwähnt wurde außerdem eine Studie, die einen signifikanten Rückgang der CABSI Rate nach Einführung eines "komplexen geschlossenen Medikationssystems", bei dem unter anderem Spritzen bis zum Wechsel am System verbleiben, zeigte [1].…”

Section: Nadelfreie Konnektionsventile (Nfc) Und Konnektionsstellenunclassified

Update Hygiene: Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen

2019

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Zusammenfassung Hintergrund Die Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) des Robert Koch-Instituts hat im Mai 2018 eine Empfehlung mit wichtigen Neuerungen zum Thema Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen herausgegeben. Ziel Zusammenfassende Darstellung, Erläuterung und kritische Diskussion der KRINKO Empfehlung. Methoden Die Empfehlungen der KRINKO wurden zusammengefasst und unter Berücksichtigung der Originalquellen diskutiert. Ergebnisse Insbesondere wurden Aussagen zur Anlage und Erhaltungspflege von Gefäßkathetern und zur Zubereitung von Infusionen formuliert. Insgesamt ist die Evidenz der Empfehlungen jedoch niedrig. Etwa 26% (19 von 74) sind unter Kategorie IA oder IB eingestuft. 40% der Empfehlungen entsprechen jedoch nur der Kategorie II, basieren also auf hinweisenden klinischen oder epidemiologischen Studien oder nachvollziehbaren theoretischen Begründungen. Entsprechend fehlt es an dringend gebrauchten klinischen Studien. Diskussion Präventionsstrategien wurden detailliert besprochen und Fragestellungen aus der Praxis aufgegriffen. Die hohe Anzahl von Einzelempfehlungen mit teils niedrigem Evidenzgrad erfordern eine gemeinsame Beurteilung von Krankenhaushygienikern und Klinikern, um eine erfolgreiche Implementierung in der Praxis und eine Fokussierung auf die wichtigsten Inhalte, adaptiert an die Situation vor Ort, zu gewährleisten.

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Using isopropyl alcohol impregnated disinfection caps in the neonatal intensive care unit can cause isopropyl alcohol toxicity

Abstract: The SwabCap altered the valves' appearance and allowed significant amounts of isopropyl alcohol to be injected. It should not be used for neonates without further research.

Cited by 13 publications

References 13 publications

Leakage of isopropanol from port protectors used in neonatal care—Results from an in vitro study

Leakage of isopropanol from port protectors used in neonatal care—Results from an in vitro study

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Update Hygiene: Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen

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