Introduction: CLABSI Causes and Consequences
Bloodstream infections are becoming one of the most pressing problems in the modern health care environment. Central line-associated bloodstream infection (CLABSI) invades the bloodstream in several ways: as a result of neglecting aseptic measures when placing the central line; because of a violation of maintenance rules; through contamination caused by touching or wetting the central line; and more (Schuldt, 2012).
If not addressed in due time, these infections can lead to a number of deplorable consequences: they result in the death of 1 in 4 affected patients, cause prolonged hospitalization, increase hospital readmission rates, and cost hospitals billions of dollars annually. Therefore, in order to prevent bloodstream infections, nurses have to follow protocols that prescribe how to care for patients with central, peripheral, and peripherally inserted central catheters (Schuldt, 2012). When these protocols are neglected, the lines can become contaminated. Fortunately, there now exist ways to help nurses prevent CLABSI more effectively and with less effort. The introduction of the Curos Disinfection Port Protector—an alcohol-impregnated cap—for maintaining sterility at the site (coupled with utilization compliance) has proven to decrease the rates of CLABSI and to help nurses manage the problem (Ramirez, Lee, & Welch, 2012).
Nurses’ Traditional Actions to Prevent Infection in Patients with Catheters
Patients with any type of line must be constantly supervised by nurses in order to prevent the possibility of blood contamination. Active disinfection guidelines, which are generally applied in hospitals that have not yet introduced passive disinfecting caps including the Curos Disinfection Port Protector, prescribe constant decontamination of the catheter hub for at least 15 seconds because needleless ports present high risks of blood infection (Cameron-Watson, 2016).
There are several other requirements nurses must follow for maintaining catheters and caps (Schuldt, 2012):
- Proper hand hygiene must be ensured before touching or placing the line.
- Dressing must be changed every week and in case of getting solid or wet.
- Caps are to be replaced every day.
- After blood draws, the catheter must be flushed with normal saline and the new cap must be attached.
- Before the cap is attached, it must be asepticized with alcohol prep.
- The IV site must be changed every four days.
- The patient and his/her family members must be instructed on how to use the catheter properly in order to avoid infections entering the bloodstream.
If a nurse fails to clean a port that is not covered by some kind of passive disinfecting cap protector before giving medications to the patient, the probability of CLABSI increases drastically.
Curos Disinfection Port Protector: Description of the Innovation
The introduction of the totally new product called Curos Disinfection Port Protector has made it possible for nurses to ensure safety while implementing catheters and has released them from the responsibility of unceasing supervision. When the protector is utilized properly, it has been proved to decrease CLABSI rates by significant percentages (more than 40%). Moreover, its use also brings about cost savings of more than $300,000 (Merrill et al., 2014).
The Curos Disinfection Port Protector is a disinfecting cap that does not require the constant active intervention of a nurse in order to provide necessary protection. It helps ensure that needleless devices, which are generally considered to be contaminated practically all the time before and after sanitation, are always sterile. The key factor that ensures sterility is the fact that the device contains a medical-grade foam pad, which is impregnated with 70% isopropyl alcohol. Thus, the process of disinfection occurs as follows: as soon as the protector is inserted into the catheter, the foam pad comes into contact with the access port and starts decontaminating it passively for about three minutes. The catheter, then saturated with disinfectant, remains under its protection for a week or until it is accessed by the patient or a nurse. Within the initial three minutes, a 5-log reduction (which equates to a decrease in the number of bacteria by 100,000-fold) is achieved. This improvement is particularly notable in comparison to the 3-log reduction of active disinfection (Cameron-Watson, 2016).
However, the effect of alcohol-impregnated port protectors has not yet been proven in hospital settings or many clinics worldwide, though they have successfully passed all the laboratory tests. Their success is partially explained by the fact that nurses’ compliance rates are very high (Sweet, Cumpston, Briggs, Craig, & Hamadani, 2012).
Application of the Device by Nurses and Patients
Being highly effective, the Curos Disinfection Port Protector is rather easy to utilize for both nurses and patients. It is a small green cap that is screwed into and left on the port, ensuring its safety until removal. Thus, when a nurse wants to access the catheter, he or she can simply unscrew the cap and attach a new one when the procedure is over. Such simplicity means that no additional coaching or instruction is required in order to ensure that all members of the nursing staff are able to successfully implement the innovation. This ease of use saves time and money for the hospital and for patients, reducing most of the risks associated with improper education of the staff (Cameron-Watson, 2016).
Current results of the device application indicate that its ease of use ranks among one of the most important factors influencing the attitudes of patients and nurses toward the innovation. The green color of the Curos Disinfection Port Protector also ensures visibility, which allows self-auditing to be performed. This feature gives patients a feeling of participation in their treatments, increases their sense of security, and encourages higher personal responsibility for their own health (Cameron-Watson, 2016).
Current nursing practice still relies largely on active disinfection methods, which implies that scrubbing remains a widespread activity. This approach is time-consuming and involves a whole number of steps. Moreover, its complexity makes it insecure and therefore fraught with dangerous consequences. From the perspective of health care providers, traditional disinfecting methods are also connected with additional responsibilities. The Curos Disinfection Port Protector frees up nurses’ time and effort by replacing the traditionally accepted method with a more comprehensible one. Perhaps most importantly, the implementation of the device leads to a 5-log reduction in bacteria, which could not have been achieved before this innovation. It has also allowed patients and nurses to reach greater compliance with catheter implementation. It has given patients a sense of empowerment as they can participate in CLABSI prevention programs and become an important part of the health care process. Besides, their assistance makes it possible for nurses to take corrective measures immediately in case of emergency—which is especially important when dealing with potential blood infections that spread in no time (Cameron-Watson, 2016).
Besides the evident medical advantages that the device provides for the nursing practice, the implementation of the Curos Disinfection Port Protector is also connected with substantial cost savings. Hospitals can save money on nursing stuff education (since no additional coaching is required), and patients can avoid hospital readmissions and further treatment for preventable diseases (Cameron-Watson, 2016).
However, because the current studies on the topic are limited in their scope as not all clinics have adopted the device yet, the research of the device in clinical settings is still insufficient.
Cameron-Watson, C. (2016). Port protectors in clinical practice: an audit. British Journal of Nursing, 25(8), S25-S31.
Hadaway, L. (2012). Needleless connectors for IV catheters. AJN The American Journal of Nursing, 112(11), 32-44.
Merrill, K. C., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact of universal disinfectant cap implementation on central line-associated bloodstream infections. American journal of infection control, 42(12), 1274-1277.
Ramirez, C., Lee, A. M., & Welch, K. (2012). Central venous catheter protective connector caps reduce intraluminal catheter-related infection. Journal of the Association for Vascular Access, 17(4), 210-213.
Schuldt, L. M. (Ed.). (2012). Preventing central line-associated bloodstream infections: a global challenge, a global perspective. Oak Brook, IL: Joint Commission Resources.
Sweet, M. A., Cumpston, A., Briggs, F., Craig, M., & Hamadani, M. (2012). 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. American Journal of Infection Control, 40(10), 931-934.