Alcohol-impregnated caps and ambulatory central-line-associated bloodstream infections (CLABSIs): A randomized clinical trial

Infect Control Hosp Epidemiol. 2021 Apr;42(4):431-439. doi: 10.1017/ice.2020.467. Epub 2020 Oct 12.

Abstract

Objective: To evaluate the effect of 70% isopropyl alcohol-impregnated central venous catheter caps on ambulatory central-line-associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients.

Design: This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial.

Setting: The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics.

Participants: All patients with an external central line followed at 1 of the 16 hematology-oncology clinics.

Intervention: Usual ambulatory central-line care per each institution using 70% isopropyl alcohol-impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol-impregnated caps.

Results: Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63-1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52-0.99). No adverse events were reported.

Conclusions: Isopropyl alcohol-impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol-impregnated caps in the ambulatory setting.

Registration: ClinicalTrials.gov; NCT02351258.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Catheter-Related Infections* / epidemiology
  • Catheter-Related Infections* / prevention & control
  • Catheterization, Central Venous* / adverse effects
  • Central Venous Catheters*
  • Child
  • Ethanol
  • Humans
  • Sepsis*

Substances

  • Ethanol

Associated data

  • ClinicalTrials.gov/NCT02351258