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Antiseptic barrier caps in central line-associated bloodstream infections: A systematic review and meta-analysis

  • Author Footnotes
    1 ST and ML contributed equally as first author.
    Sofía Tejada
    Correspondence
    Corresponding author at: Vall d'Hebron Institut de Recerca, Ps Vall d'Hebron 119 AMI-14th floor, 08035 Barcelona, Spain.
    Footnotes
    1 ST and ML contributed equally as first author.
    Affiliations
    Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain

    Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
    Search for articles by this author
  • Author Footnotes
    1 ST and ML contributed equally as first author.
    Marta Leal-dos-Santos
    Footnotes
    1 ST and ML contributed equally as first author.
    Affiliations
    Hospital de Curry Cabral, Lisbon, Portugal
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  • Yolanda Peña-López
    Affiliations
    Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain

    Paediatric Critical Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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  • Stijn Blot
    Affiliations
    Department of Internal Medicine & Paediatrics, Ghent University, Ghent, Belgium

    Burns, trauma & Critical Care Research Centre, Faculty of Medicine, Brisbane, Australia
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  • Emine Alp
    Affiliations
    Ankara Yıldırım Beyazit University, Ankara, Turkey
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  • Jordi Rello
    Affiliations
    Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain

    Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain

    Clinical Research in the ICU, Anaesthesia Department, CHU Nimes, Universite de Nimes-Montpellier, France
    Search for articles by this author
  • Author Footnotes
    1 ST and ML contributed equally as first author.
Published:February 10, 2022DOI:https://doi.org/10.1016/j.ejim.2022.01.040

      Highlights

      • Antiseptic barrier caps appear to be effective in reducing CLABSI.
      • ICU patients, adults, and observational studies associated with significant benefit.
      • No benefit in children.
      • Compliance with antiseptic barrier cap use was high and costs were lower.
      • The real-world impact needs to be confirmed by RCTs.

      Abstract

      Objectives

      To evaluate the evidence concerning the effectiveness of antiseptic barrier caps vs. manual disinfection in preventing central line-associated bloodstream infection (CLABSI).

      Methods

      The protocol of this systematic review and meta-analysis was pre-registered in PROSPERO (CRD42021259582). PubMed, Cochrane Library and Web of Science databases were searched from 2011 to 2021. Randomized-controlled trials (RCT) and observational studies on hospitalized patients of any age were included.

      Results

      Fourteen studies were included. Compared with manual disinfection, antiseptic barrier caps significantly reduced CLABSI rate per 1000 line-days (Standardized Mean Difference [SMD]: -0.02; 95%CI: -0.03 to -0.01) and number of CLABSI per patient (RR: 0.60; 95%CI: 0.41–0.89). Subgroup analysis showed that antiseptic barrier caps were more effective in reducing CLABSI rate per 1000 line-days in ICU (SMD: -0.02; 95%CI: -0.03 to -0.01) and non-ICU patients (SMD: -0.03; 95%CI: -0.05 to -0.01), adults (SMD: -0.02; 95%CI: -0.04 to -0.01), as in observational studies (SMD: -0.02; 95%CI: -0.02 to -0.01). Antiseptic barrier caps also significantly reduce CLABSI risk in ICU patients (RR: 0.65, 95%CI: 0.42–1.00), adults (RR: 0.50, 95%CI: 0.29–0.86), and observational studies (RR: 0.54; 95%CI: 0.32–0.91). No differences were found when only children or RCTs were taken into account. Median cost savings amongst studies were $21,890 [IQR 16,350–45,000] per CLABSI.

      Conclusions

      Antiseptic barrier caps appear to be effective in reducing CLABSI. The real-world impact needs to be confirmed by RCTs.

      Keywords

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