Running head: REFLECTION OF RESEARCH 1

Reflection of Research
Cassaundra Braden
Ferris State University

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Abstract
This paper reviews research focused on answering a question regarding infection control.
The articles reviewed discuss a new approach to disinfection of central venous catheters in order
to decrease the occurrence of central line associated bloodstream infections. The authors goal is
to promote the use of nursing research to advance the professional nurses practice.

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Reflection of Research
The purpose of this paper is interpret and use evidence-based research to support nursing
decisions. The goal is to reflect on how well nursing knowledge is available and utilized in
personal and professional practice. By assessing current nursing research findings we can
determine if they are being applied in various clinical practice environments and populations.
PICO Question
The question that is to be answered by nursing research is: Do alcohol impregnated caps
reduce central line associated blood stream infections in patients with central venous catheters?
Patient safety is at risk when a central line is in place due to the increased infection rates. In
order to improve patient quality and safety it is necessary to research methods that may decrease
this risk. There is proficient research regarding alcohol caps for central lines that should be
assessed when caring for a patient with risk for infection related to these lines.
As a health care professional it is important to include evidence based research in your
practice. If research is not used as a resource to improve patient outcomes, patients are not
receiving the best possible care. When research is conducted that applies to a nurses healthcare
setting, it is that nurses responsibility to assess the information and communicate it other
professionals. A nursing leader should promote the research if it will benefit the patient
population. Incorporating alcohol caps in a long term acute care facility, or oncology unit that
has a large amount of peripherally inserted central catheters will decrease risk of central line
infections and therefore should be considered to improve patient outcomes.

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Research Findings
Numerous research has been conducted regarding alcohol impregnated caps being used to
decrease central line associated blood stream infections. One study out of NorthShore University
HealthSystem stated "Catheter hub decontamination requires a thorough scrub and compliance
varies" (Wright et al, 2013). The authors used disinfection caps with a small sponge saturated
with 70% isopropyl which is threaded on to any lumen not actively in use and remains in place
until the lumen is accessed. When the cap is removed it is discarded and a new cap is threaded
on to the lumen saturating it in alcohol. The study involved 3 phases in which the rate of
CLABSI infections were monitored. The initial phase involved continuing to use an alcohol
wipe to scrub the hub prior to accessing the line. In the second phase the disinfection caps were
used on all patients with central lines. The final phase required removal of all caps and returning
to the original practice from phase one. This study is appropriate for answering the question
asked regarding alcohol impregnated central line caps. The sample size was three hospitals wide
and involved 799 patients with central lines which was large enough to determine correlations.
The study found that the contamination rate was 12.7% during the first phase and 5.5% when the
disinfection caps were used. The rate increased back up to 12.0% when the caps were
discontinued and alcohol swabbing was restarted. Based on this study a nursing leader should
advocate for the use of alcohol impregnated caps on a patient population with a large amount of
individuals requiring the use of central lines.
An article published in the American Journal of Infection Control states a major risk
factor for the development of a blood stream infection is the presence of a central venous
catheter (Sweet et. al.). The authors used an observational before and after trial in a tertiary
care hospital specializing in oncology. During the pre-intervention period the hospital
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experienced sixteen central line associated bloodstream infections (CLABSI) which
corresponded with a rate of 2.3 infections per 1,000 central line days. When the hospital
initiated the use of luer-lock style alcohol caps which provided scrubbing and cleaning as the
protectors are twisted onto and off of the catheter hubs, there was only one CLABSI recorded.
This intervention period totaled a rate of 0.3 infections per 1,000 central line days. As a nursing
professional assessing this study for application into personal practice it would be important to
consider that the intervention period in this study was six months while the pre-intervention
period was one year. Regardless of this technicality the data proves that the use of alcohol
impregnated port protectors significantly reduced the rate of central line infections. The author
states resistant organism can be challenging to treat and are associated with increased mortality
and morbidity. The paradigm for dealing with health care associated infection needs to shift
from treatment to prevention (Sweet et. al., 2012).
A final article in Infection Control and Hospital Epidemiology used a different approach
to assess the effectiveness of antiseptic barrier caps on central venous catheters. The researchers
acquired one hundred five needless valve connectors from three different manufacturers and
contaminated them with Enterococcus faecalis. These pre-contaminated connectors were
accessed without disinfecting, with a vigorous 3-5 second swab using 70% alcohol wipe, and
finally with an antiseptic alcohol impregnated cap left in place for ten minutes. Of the
connectors not disinfected 100% showed transmission of E. faecalis across the membranous
septum. In the group of connectors swabbed with a 70% alcohol wipe there was a 67%
transmission of E. faecalis. The final group in which the antiseptic cap was used showed a 1.6%
transmission of E. faecalis. This study, while not involving clinical trials, provided strong
evidence to support the use of alcohol impregnated caps in a patient population such as long term
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acute care involving the frequent use of central lines. An additional concern the authors brought
up stated that bloodstream infections cause an increased cost to the hospital. BSIs are
associated with substantial prolongation of hospital stay and marginal costs to healthcare systems
of $33,000-$35,000 per episode (Menyhay, 2006). This is an important factor to consider when
advocating for your patient and your practice.
Recommendations to Improve Quality and Safety
The results of bloodstream infections can be tragic (Maki, 2008). In a profession
dealing with the lives of patients who are already immunocompromised it is critical to do
everything possible to prevent further complications to their morbidity. Research findings
should be assessed and integrated into practice if they prove to be beneficial to patient safety and
can improve quality of care. In a patient population, such as long term acute care or oncology,
where central lines are used regularly it is the job of the nursing professional to incorporate
nursing research to advance patient outcomes.
Conclusion
The research discussed in this paper provides enough evidence to promote the nursing
professional to advocate towards use of alcohol impregnated caps in place of alcohol swabbing
in a practice involving the use of central lines in patients. Nursing research exists to advance the
medical profession. As a nursing professional it is necessary to assess this research and utilize it
to improve patient care in your practice.

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References
Maki, D., & Menyhay, S. (2006). Disinfection of needleless catheter connectors and access ports with
aocohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap.
Infection Control and Hospital Epidemiology, 17(1), 23-27. Retrieved November 28, 2013, from
www.jstor.org
Menyhay, S., & Maki, D. (2008). Preventing central venous catheter-associated bloodstream infections:
Development of an antiseptic barrier cap for needleless connectors. American Journal of
Infection Control, 36(10). Retrieved November 28, 2013, from www.ajicjournal.org
Sweet, M., 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, 931-934. Retrieved November 28, 2013, from
www.ajicjournal.org
Wright, M., Tropp, J., Schora, D., Dillon-Grant, M., Peterson, K., Boehm, S., et al. (2013). Continuous
passive disinfection of catheter hubs prevents contamination and bloodstream infection.
American Journal of Infection Control, 41, 33-38. Retrieved November 28, 2013, from the
Elsevier database.