Curos™ Disinfection Caps for the Prevention of Infection When Using Needleless Connectors: A NICE Medical Technologies Guidance
Tóm tắt
Central line-associated bloodstream infections (CLABSIs) are primary, laboratory confirmed bloodstream infections in patients with a central line within 48 h of symptom onset. Catheter-related bloodstream infection (CRBSI) is a more specific term used when the cause of infection has been confirmed by catheter tip cultures. CLABSIs and CRBSIs occur as a result of bacteraemia originating from intravenous catheters. Bloodstream infections are associated with increased length of stay, mortality and increased cost in treatment. The ability of Curos™, a disinfecting cap for needleless connectors of vascular access lines, to prevent bloodstream infections was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). Curos is a single-use device that contains a foam that is impregnated with 70% isopropyl alcohol; use of Curos is claimed to avoid the need to manually disinfect needleless connectors. Curos disinfection caps may contribute to the prevention of CLABSIs and CRBSIs as part of a bundle of infection prevention processes; however, the evidence for Curos is limited in both quantity and quality and may not be generalisable to National Health Service (NHS) practice. Therefore, the guidance published by NICE in May 2019 recommended further research to address uncertainties regarding the clinical benefits of using Curos.
Tài liệu tham khảo
Campbell B, Campbell M. NICE medical technologies guidance: a novel and rigorous methodology to address a new health technology assessment challenge. Appl Health Econ Health Policy. 2012;10(5):295–7.
O’Connell S, Dale M, Morgan H, Carolan-Rees G. Curos disinfecting caps for infection prevention in needleless connectors (external assessment report). 2018. https://www.nice.org.uk/guidance/mtg44/documents/supporting-documentation-2. Accessed 19 Dec 2019.
National Institute for Health and Care Excellence. Curos for preventing infections when using needleless connectors [MTG44]. National Institute for Health and Care Excellence; 2018. https://www.nice.org.uk/guidance/mtg39. Accessed 19 Dec 2019.
Cameron-Watson C. Port protectors in clinical practice: an audit. Br J Nurs. 2016;25(8):S25–31. https://doi.org/10.12968/bjon.2016.25.8.S25.
Duncan M. A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters. J Assoc Vasc Access. 2018;23(1):15–22.
Martino A, Thompson L, Mitchell C, Trichel R, Chappell W, Miller J, et al. Efforts of a Unit Practice Council to implement practice change utilizing alcohol impregnated port protectors in a burn ICU. Burns. 2017;43(5):956–64.
Merrill KC, Sumner S, Linford L, Taylor C, Macintosh C. Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. Am J Infect Control. 2014;42(12):1274–7. https://doi.org/10.1016/j.ajic.2014.09.008.
Ramirez C, Lee AM, Welch K. Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection. J Assoc Vasc Access. 2012;17(4):210–3. https://doi.org/10.1016/j.java.2012.10.002.
Sweet MA, Cumpston A, Briggs F, Craig M, Hamadani M. Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. Am J Infect Control. 2012;40(10):931–4. https://doi.org/10.1016/j.ajic.2012.01.025.
Alasmari Faisai KN, Russo Anthony J, McMullen Kathleen M (eds). Impact of Alcohol Impregnated Protectors on Incidence of Catheter-Associated Blood Stream Infections. ID Week. Advancing Science, Improving Care; 2012; San Diego, CA.
Budhiraja S, Clargo H, McLellan E, Pilling E. G573(P) Impact of passive disinfection device on the rate of catheter related blood stream infections in neonates: a quality improvement initiative. Arch Dis Child. 2016;101(Suppl 1):341. https://doi.org/10.1136/archdischild-2016-310863.559.
Danielson B, Willamson S, Kaur G, Brooks C, Scholl P, Baker A. Decreasing the incidence of central line-associated blood stream infections using alcohol-impregnated port protectors in a neonatal intensive care unit. Am J Infect Control. 2013;41(6):S97–8.
Kwok MWN. Trial use and evaluation of disinfecting port protectors on central venous catheter in hematology ward in Hong Kong. Antimicrob Resist Infect Control. 2017;6(25):29.
Madden W, Dockery J, Smith J, Bowman WB, Macke M. Alcohol impregnated caps: are they effective for preventing CLABSI? Biol Blood Marrow Transpl. 2013;19(2):S371. https://doi.org/10.1016/j.bbmt.2012.11.598.
Pong A, Salgado C, Speziale M, Grimm P, Abe C. Reduction of central line associated bloodstream infection (CLABSI) in a neonatal intensive care unit with use of access site disinfection caps. In: Poster 672. Infectious Disease Society of America Annual Meeting. 20–23 Oct 2011: Boston, MA.
Shiber J, Jolicoeur G, Crouchet T. Reducing central line-associated bloodstream infections through the addition of disinfecting port protector caps to the central line bundle In: Annual Research Day, New Orleans, LA; 20 May 2014.
Sumner S, Merrill KC, Linford L, Taylor C. Decreasing CLABSI rates and cost following implementation of a disinfectant cap in a tertiary care hospital. Am J Infect Control. 2013;41(6):S37.
Ventura R. Passive disinfection port protector: effect on the reduction of catheter related bloodstream infections. In: Gavacelt Conference 2015: Milan.
GRADEpro GDT: GRADEpro Guideline Development Tool [software] (developed by Evidence Prime, Inc.). McMaster University; 2015. Available at: gradepro.org.
Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86(Suppl 1):S1–70. https://doi.org/10.1016/S0195-6701(13)60012-2.