Changing Disinfecting Cap Protocol: A CLABSI Reduction Initiative

Background: Central Line-Associated Bloodstream Infections (CLABSIs) cause an increased risk of mortality and cost to patients and hospitals. Short-staffing, non-compliance, and inadequate training are all possible contributing factors to an increase in CLABSIs. Antiseptic barrier caps are a possible preventative measure impregnated with 70% isopropyl alcohol. These caps are meant to cover needleless injection ports and keep them clean and protected. There is evidence showing a reduction in CLABSIs with these caps. However, more research is needed. Local Problem:Throughout the United States, CLABSI rates have increased. The COVID-19 pandemic saw an increase of over 50% in CLABSIs. At the site where this project took place, CLABSI rates have increased by 75% in the last six years, from 21 to 28 infections. Methods: The project manager created a pre-survey to assess current practices and readiness for change. Then, an in-service was completed, where nurses were individually given a demonstration, explanation, and teach-back. Observations were made after implementation to assess compliance, and after three months of this implementation, a post-survey was distributed to assess usability and satisfaction. The practice implementation was described as taking off the disinfecting cap, scrubbing the hub of the needleless injection port for five to fifteen seconds, and then connecting any medication or infusion. Once the medication or infusion is completed, disconnect it and scrub the hub for five to fifteen seconds with a new alcohol swab. Once it has dried, a new disinfecting cap may be applied. Observations of drug administrations were completed to assess compliance. At the end of the project period, nurses were given a post- survey to evaluate current practice and assess for any change in practice and knowledge. Interventions: The survey questions were derived using the University of Utah's IV Standards Summation and Comprehensive Management of Intravenous Catheters policy. The observation checklists were totaled to count the number of correct administrations. Results: Out of 57 nurses who participated in the project, 38 (67%) completed the pre-initiation survey, and 32 (56%) completed the post-initiation survey. Twenty-eight drug administrations were observed, with six (21%) of them performed correctly per the new protocol. No CLABSIs occurred during the project period of four months. An average of 15% increase in correct answers was seen in the education portion of the surveys. Of the nurses who completed the initial survey, 71% (27) said this project might reduce CLABSIs. However, the procedure change was inadequately followed. Conclusion: Considering low compliance rates, it is uncertain if adding a five-to fifteen- second alcohol scrub time between disinfecting cap application and removal is beneficial. Overall knowledge regarding central line care increased, indicating that in-person, frequent education on central line care may be beneficial.