NICUs and PICUs Don’t Benefit From Antiseptic Barrier Caps

Although the use of antiseptic barrier caps reduces the occurrence of central line−associated blood-stream infections (CLABSI) in adult intensive care settings, they don’t significantly reduce those infections in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs), according to a study in the American Journal of Infection Control. 

Still, say investigators with MC-Sophia Children’s Hospital, Rotterdam, the Netherlands, the nurses on the wards “highly valued” the barrier caps because they believed they saved time and increased patient safety. Nurses who treated the 2248 patients involved in the study adhered to the antiseptic barrier cap protocol for both NICUs (95.2%) and PICUs (89%).

“The rate of CLABSIs per 1,000 catheter days declined from 3.15 to 2.35, resulting in an overall incidence reduction of 22% (95% confidence interval, −34%, 55%; P = .368),” the study states.  

The mixed-method, prospective, observational before-after study was performed in a large tertiary academic children’s hospital in the Netherlands and included a preintervention period and an intervention period. The NICU holds 34 beds and sees about 750 admissions a year. The PICU holds 28 beds with about 1500 admissions a year. Both can provide complex medical care to extremely low-birth-weight infants that includes surgical repair of complex congenital cardiac malformations, and extra corporal membrane oxygenation.

“Gram-negative pathogens were the predominant causative pathogens for CLABSI,” the study states. “Still, it is more likely that patients admitted to our NICU and PICU suffer from bacteremia due to gram-positive micro-organisms.”

The study included all infants admitted to the NICU or PICU who had a central venous catheter in place. The 24-month preintervention period ran from May 1, 2014, to April 30, 2016. The intervention period ran from May 1, 2016, to April 30, 2017. In the preintervention period, nurses disinfected the needleless connectors according the hospital protocol by rubbing with a gauze impregnated with 70% alcohol combined with 10% isopropyl alcohol, then air-drying for 30 seconds. During the intervention period, the antiseptic barrier cap was introduced and after each access, a new antiseptic barrier cap was placed onto the needleless connector.  

“The reducing effect of the use of antiseptic barrier caps on the occurrence of CLABSI per 1,000 CVC days seems to be more prominent in the NICU population compared with the PICU population,” the study states. “A possible explanation is the longer median CVC insertion duration in the NICU compared with the PICU, respectively 8 and 3 days.” 

Investigators add that they could not “rule out that other outcome-relevant elements apart from the introduction of the antiseptic barrier cap were altered during the study period. Still, major potential confounders, such as the antibiotic protocol and the CVC insertion procedures, did not change during the study period.”