| Primary Author: | Judy Smith, MSN, RN, CRNI |
| Co-Principal Investigators/Collaborators: | Mary Viney, RN, MSN, CPHQ, Gwen Irwin, RN, CRNI, VA-BC, Lynda Watkins, RN, BSN, MPH, CIC, Shonnie Pinno Morris, BSMT, ASCP, SM, Adama Brown, PHD, Kenn Kirksey, PH, PhD, ACNS-BC |
| Organization | Seton Healthcare Family |
Abstract
Purpose
To examine the associations between alcohol scrub times (5, 8, 10, 12, and 15 seconds) and bacterial transfer through needleless connectors.
Background
Elimination of central line-associated bloodstream infections (CLABSI) is a major focus in American healthcare. According to the Centers for Disease Control (2011) and the Infusion Nurses Society (2011), the optimal time for intravenous needleless connector disinfection has not yet been empirically established.
Materials & Methods
Using experimental design and established lab procedure (clean gloves only), a 0.5 MacFarland suspension was used to inoculate 172 Microclave needleless connectors with bacteria (S. aureus, S. epidermidis, P. aeruginosa) and allowed to dry for 18 hours. Five groups of connectors (n = 27 per group) were disinfected using 70% isopropyl alcohol with friction for 5, 8, 10, 12 and 15 seconds; and flushed with 0.5 ml non-bacteriostatic sterile normal saline onto sheep-blood agar plates for incubation at 35C for 48 hours. Bacterial growth (a colony at the edge of the plate) was noted on 2 negative controls; therefore, a second sample (N = 172) was inoculated using additional precautions of masking, gloving and gowning.
Results
Group 1 showed significant (Chi-square = 37.93; df = 4; p = .000) and strong (Cramer’s V = .53; p = .000) associations between scrub time and growth status. Scrub times of 5, 8, 10, 12 and 15 seconds yielded positive cultures in 59.3%, 40.7%, 11.1%, 0.0% and 7.4% of agar plates, respectively. In Group 2, scrub times of 5, 8, 10, 12 and 15 seconds yielded positive cultures in 30.0%, 30.0%, 15.0%, 11.1% and 11.1% of agar plates, respectively. While not statistically significant, Group 2 associations were clinically significant.
Conclusion
While additional research is warranted, this study showed that disinfection times of 5 and 8 seconds were inadequate for reducing bacterial transfer. However, disinfection times of 10, 12 and 15 seconds resulted in comparable, decreased rates of bacterial migration.
Bibliography
Alexander, M. (Ed.). (2011). Infusion Nursing Standards of Practice (Supplement). Journal of Infusion Nursing, 34(1S).
Kaler W. Successful disinfection of needleless mechanical access ports: a matter of time and friction. Journal of the Association for Vascular Access, 2007; 12(4): 203-205
Menyhay S, Maki D (2006). Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap. Infection Control and Hospital Epidemiology, 27(1): 23-27.
O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., et al (2011). Guidelines for the prevention of intravascular catheter-related infections. Available at http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html
Simmons, S., Bryson, C., Porter, S. (2011). “Scrub the hub” Cleaning duration and reduction in bacterial load on central venous catheters. Critical Care Nursing Quarterly, 34(1), 31-35.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).