Central Venous Catheter Injection Cap Disinfection: Chlorhexidine Versus 70% Alcohol

Abstract

The hospital practice for central venous catheter (CVC) injection cap disinfection consisted of a 15-second 70% alcohol wipe scrub followed by a 15-second dry time. As part of the initiative to reduce central line-associated blood stream infections (CLA-BSI), the organization wanted to determine the best practice for injection cap disinfection. For hospitalized pediatric patients with a CVC, does the use of chlorhexidine to scrub CVC injection caps reduce the incidence of CLA-BSI rates when compared with the use of 70% alcohol? A literature search was performed that yielded two randomized clinical trials in the past 16 years. The evidence was rated and classified based on the Oncology Nursing Society's Putting Evidence into Practice weight of evidence classification schema. Additional sources of evidence obtained from benchmark data, listserv queries, and manufacturer recommendations were evaluated. The body of evidence was classified as “effectiveness not established” because there was insufficient data and inadequate data quality. No research studies were found that strongly supported the use of chlorhexidine for injection cap disinfection to reduce CLA-BSI rates even though the literature and benchmark data demonstrated a shift toward the use of chlorhexidine for injection cap disinfection. Our current hospital practice of using 70% alcohol was determined to be within the national practice standards. Further research is needed to better determine the most effective CVC injection cap cleanser for prevention of CLA-BSI.