title: Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a passive catheter care system.
abstract: BACKGROUND
  Bacterial contamination of intravascular devices has been associated with increased morbidity and mortality in various hospital settings, including the perioperative environment. Catheter hub disinfection has been shown in an ex vivo model to attenuate intraoperative injection of bacterial organisms originating from the anesthesia provider's hands, providing the impetus for improvement in intraoperative disinfection techniques and compliance. In the current study, we investigated the clinical effectiveness of a new, passive catheter care station in reducing the incidence of bacterial contamination of open lumen patient IV stopcock sets. The secondary aim was to evaluate the impact of this novel intervention on the combined incidence of 30-day postoperative infections and IV catheter-associated phlebitis.
  
  
  METHODS
  Five hundred ninety-four operating room environments were randomized by a computer-generated list to receive either a novel catheter care bundle (HubScrub and DOCit) or standard caps in conjunction with a sterile, conventional open lumen 3-way stopcock set (24 inch with 3-gang 4-way and T-Connector). Patients underwent general anesthesia according to usual practice and were followed prospectively for 30 postoperative days to identify the development of health care-associated infections (HCAIs) and/or phlebitis. The primary outcome was intraoperative bacterial contamination of the primary stopcock set used by the anesthesia provider(s). The secondary outcome was the combined incidence of 30-day postoperative infections and phlebitis.
  
  
  RESULTS
  Five hundred seventy-two operating rooms were included in the final analysis. Study groups were comparable with no significant differences in patient, provider, anesthetic, or procedural characteristics. The catheter care station reduced the incidence of primary stopcock lumen contamination compared with standard caps (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.63-0.98, P = 0.034) and was associated with a reduction in the combined incidence of HCAIs and IV catheter-associated phlebitis with and without adjustment for patient and procedural covariates (OR(adjusted) 0.589, 95% CI 0.353-0.984, P = 0.040). The risk-adjusted number needed to treat to eliminate 1 case of lumen contamination was 9 (95% CI 3.4-13.5) patients, whereas the risk-adjusted number needed to treat to eliminate 1 case of HCAI/catheter-associated phlebitis was 17 (95% CI 11.8-17.9) patients.
  
  
  CONCLUSIONS
  Intraoperative use of a passive catheter care station significantly reduced open lumen bacterial contamination and the combined incidence of 30-day postoperative infections and phlebitis.
authors.affiliation: Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756, USA. randy.w.loftus@hitchcock.org
authors.forename: Randy W
authors.initials: RW
authors.lastname: Loftus
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Brindeiro
authors.forename: David P
authors.initials: DP
authors.lastname: Kispert
authors.forename: Hetal M
authors.initials: HM
authors.lastname: Patel
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Koff
authors.forename: Jens T
authors.initials: JT
authors.lastname: Jensen
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Dodds
authors.forename: Mark P
authors.initials: MP
authors.lastname: Yeager
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Ruoff
authors.forename: John D
authors.initials: JD
authors.lastname: Gallagher
authors.forename: Michael L
authors.initials: ML
authors.lastname: Beach
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology; D003710:Demography; D004203:Disinfection / Q000379:methods; D004311:Double-Blind Method; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007275:Injections, Intravenous / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D010689:Phlebitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D014193:Trauma Centers; D016896:Treatment Outcome