* Catheter-related bloodstream infections (CRBSI) are the most common hospital acquired illness. * 62,000 people die each year from a central line infection. (World Health Organization, 2014) * 250,000 bloodstream infections occur annually within the hospital setting.

Search Words: central line, disinfection cap, decontamination, infection, and prevention. Search results: Both search engines provided the best results when using “central line infection + disinfection caps”. CINAHL resulted in 138 articles, whereas Pubmed only listed 5. Search Engines: CINAHL and Pubmed

Two articles were reviewed from the American Journal of Infection Control (AJIC). The first article involved a multi-facility study which tested the use of disinfection caps against the standard scrubbing method (Wright et al., 2013). The second article was a two year study in which results were compared from utilizing the standard scrubbing method for the first year, and utilizing the disinfection caps the following year (Wawrzyniak et al., 2014).

 PICO QUESTION: In patients with central lines, would the use of alcohol-infused disinfection caps, as compared to scrubbing the hub with alcohol, reduce catheter-associated infections? The two articles each involve a study specifically focused on the use of disinfection caps for central lines. They both compare this approach with the previously accepted standard scrubbing method. These experiments are ideal for gathering information on the proposed PICO question. (Wawrzyniak et al., 2014; Wright et al., 2014)

The concept- Central line infection rates should fall with improved line disinfection. The theory- Alcohol infused disinfection caps will provide better infection control.

Article 1: * Multi-facility, Quasi-experimental * Three phases: 1. Standard scrub 2. Disinfection cap 3. Back to standard scrub Who? Adult inpatients with at least five days of admission What? 1.5mL of blood drawn from central line When? Twice a week Why? Tested for bacterial growth Article 2: One facility, 2 year pre and post observational study Who? All patients in the facility, including pediatrics What? Infection rates When? One year of standard scrub method, and one year of utilizing disinfection caps Why? To determine which method best decreases infections rates (Wawrzyniak et al., 2014) (Wright et al., 2014 )

Article 1: * The use of disinfection caps effectively decreased infection rates in each facility. * If an infection did occur, it included less organisms as compared to the standard scrubbing method. * When returning to the standard scrubbing method, infection rates increased. * Each facility has now implemented these caps as part of their standard of practice. Article 2: * Standard scrubbing method: 59 infections * Disinfection caps: 23 infections * 68% overall decrease in infection rate. (Wawrzyniak et al., 2014) (Wright et al., 2014)

* Informed consent * Confidentiality * Choosing who receives treatment (justice) * Proper review from the Institutional Review Board (IRB) (Blessing & Forister, 2013)

 Both studies provided clear and concrete methods and results.  The first study used multiple facilities, which helps to make the evidence more credible.  The second study used multiple types of patients and diagnoses, along with a long two year span of collecting information. (Wawrzyniak et al., 2014; Wright et al., 2014)

 Both articles were published in the AJIC, a major resource for epidemiology, disease prevention, and infectious diseases.  AJIC has a large editorial board with over fifty health professionals.  The board is comprised of pharmacists, registered nurses, and physicians.  The articles are peer-reviewed.  The authors all practice medicine with varying degrees such as MD’s and RN’s with BSN and/or MSN. (Wawrzyniak et al., 2014; Wright et al., 2014; AJIC, 2014)

 The evidence from all of the studies show an improvement in infection rates when the alcohol-infused disinfection caps were used.  Multiple facilities have implemented these caps into their standard of practice due to the level of evidence found in these articles and other previous studies. (Wawrzyniak et al., 2014; Wright et al., 2014)

The findings from the disinfection caps have shown nothing but positive outcomes to patient care, which makes them relevant to the field. They have the potential to save multiple lives. Once facilities choose to implement them, staff education would be needed. The caps have a possibility of being considered an overall standard of professional practice.

 Findings indicate a strong potential for change in the standard of care.  Infection rates in both studies have substantially declined, increasing patient safety.  The caps are simple, quick, and cost effective.  The major barrier would be for staff to remember to include them into their routine.

In patients with disinfection caps on their central lines, would leaving the cap on for a maximum of four days, as compared to changing it on a daily basis, decrease the rate of infection? In patients with central lines, would scrubbing the hub with betadine, as compared to rubbing alcohol, decrease the rate of infection?

 Alcohol-infused disinfection caps have reduced the rates of infection in patients with a central line.  Not only does this prevent unnecessary hospital stays and medical bills, but it can spare the lives of many people who experience these types of infections. (Wawrzyniak et al., 2014; Wright et al., 2014)

 American Journal of Infection Control (AJIC). (2014). Current issue. Retrieved from  Blessing, J.D. & Forister, J.G. (2013). Introduction to research and medical literature for health professionals. (3 rd ed.). Burlington, MA: Jones & Bartlett Learning, LLC.  Wawrzyniak, M.M, Parada, J., Lewis, K., Mallek, A., Suarez-Ponce, S., Trulis, E., & … Tomich, A. (2014). Significant improvement in CLABSI rates following routine use of disinfection caps on all access ports: Better safety, better resource utilization. American Journal of Infection Control, 42, S15-6. doi: /j.ajic

 World Health Organization (WHO). (2014). Preventing bloodstream infections from central line venous catheters. Retrieved from ntation/bsi/en/  Wright, M., Tropp, J., Schora, D.M., Dillon- Grant, M., Peterson, K., Boehm, S., & … Peterson, L.R. (2013). Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. American Journal of Infection Control, 41(1), doi: /j.ajic