Title: Impact of Alcohol Impregnated Port Protectors and Needleless Neutral Pressure Connectors on Central Line-Associated Blood Stream Infections and Contamination of Blood Cultures in an Oncology Population

Background: Patients with central venous catheters are at increased risk for central line-associated blood stream infections (CLABSI) and unnecessary treatment due to contaminated blood cultures. CLABSI and contaminated blood cultures are associated with improper care of central line hubs. Oncology patients are at especially high risk for these complications. 

Objective: To decrease the rates of CLABSI and contaminated blood cultures by implementing alcohol impregnated port protectors and needleless neutral pressure connectors to all central venous catheters on the oncology ward.

Methods: During the intervention period the practice of central line hub care was changed from traditional alcohol wipes to using an alcohol impregnated port protector. To accommodate the port protectors, the needleless hubs were changed to a neutral pressure connector. The study locations were the 12-bed Blood and Marrow Transplant and 20-bed Oncology Units. We conducted an observational study to evaluate the impact of the interventions.  The six month intervention period (January-July 2010) was compared to historical control (January-December 2009). Compliance with the impregnated caps was monitored weekly. 

Results: During the control period, there were 895 admissions contributing 5494 line days and 16 infections (2.9 infections/1000 central line days). During the intervention period, there were 475 admissions with 2493 line days and 1 infection (0.4 infections/1000 central line days) (P=0.0318).  Had the rate of infections not been reduced, we would have expected to see 7 infections during the study period. The rate of contaminated blood cultures from central lines was 2.5% (17/692) and 0.2% (1/470) during the control and intervention period (P= 0.002), respectively. Estimated annualized costs associated with CLABSI and contaminated blood cultures was $565,000 and $65,000 during the two periods, resulting in a cost avoidance of $500,000. The rate of compliance was >90% for the study period.

Conclusions: The implementation of an alcohol impregnated port protector and needleless neutral pressure connector significantly reduced the rate of CLABSI in our oncology population. In addition, the rate of contaminated blood cultures was significantly reduced. This intervention was easily introduced, with a high rate of compliance and significant cost reduction to our hospital.