Cap use and disinfection techniques are among the evidence-based best practices the INS recommends. Here are five highlights:
1. Disinfect and cap all lines
In 2016, the INS advised clinicians to protect central lines with disinfectant caps. 2021 standards go further saying all catheter lines, not just central lines, should be capped.
Clinicians know that central lines are accessed frequently across units—several times a day for blood draws, maintenance flushes, medication and fluid delivery, dialysis and other treatments. That increases infection risk. But all IV lines can be contaminated from exposure to skin, bodily fluids, soiled linens and airborne pathogens that can lead to a CABSI.3
“Until now, we’ve placed a lot of focus on central lines, but it’s all one bloodstream,” says Nolte who has seen firsthand how complex vascular access management can be at hospitals. “This standard recognizes that if not properly maintained and disinfected, all IV access points are an open door for contaminants. Any type of catheter can cause a CABSI.”
2. Follow best practices for active or passive disinfection
Many clinicians practice an active “scrub the hub” disinfection technique using 70% alcohol pads and that can work. But the INS cites evidence that “active disinfection” with 70% alcohol-based chlorhexidine gluconate (CHG) swab pads or “passive disinfection” using disinfection caps is much more effective in reducing CABSI than alcohol pads alone.
“Active techniques like scrubbing have more room for human error,” explains Nolte. “Disinfecting the threads and surfaces of needleless connectors properly and consistently with alcohol wipes can be tricky. The amount of friction used and for how long differs from person to person and different disinfectants and dry times have different results in microbial kill. Good practices fall off when clinicians are rushed or distracted and missteps like reusing wipes and setting connectors down on surfaces introduce bacteria. Finally, scrubbing practice is hard to monitor.”
In other words, human factors in active disinfection—variability in technique, training and consistency—can lead to ineffective practice that allows bacteria to enter the intraluminal surface of the catheter. And that increases CABSI risk.4