title: Antiseptic barrier cap effective in reducing central line-associated bloodstream infections: A systematic review and meta-analysis.
abstract: BACKGROUND
  Microorganisms can intraluminally access a central venous catheter via the catheter hub. The catheter hub should be appropriately disinfected to prevent central line-associated bloodstream infections (CLABSIs). However, compliance with the time-consuming manual disinfection process is low. An alternative is the use of an antiseptic barrier cap, which cleans the catheter hub by continuous passive disinfection.
  
  
  OBJECTIVE
  To compare the effects of antiseptic barrier cap use and manual disinfection on the incidence of CLABSIs.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  We systematically searched Embase, Medline Ovid, Web-of-science, CINAHL EBSCO, Cochrane Library, PubMed Publisher and Google Scholar until May 10, 2016. The primary outcome, reduction in CLABSIs per 1000 catheter-days, expressed as an incidence rate ratio (IRR), was analyzed with a random effects meta-analysis. Studies were included if 1) conducted in a hospital setting, 2) used antiseptic barrier caps on hubs of central lines with access to the bloodstream and 3) reported the number of CLABSIs per 1000 catheter-days when using the barrier cap and when using manual disinfection.
  
  
  RESULTS
  A total of 1537 articles were identified as potentially relevant and after exclusion of duplicates, 953 articles were screened based on title and abstract; 18 articles were read full text. Eventually, nine studies were included in the systematic review, and seven of these nine in the random effects meta-analysis. The pooled IRR showed that use of the antiseptic barrier cap was effective in reducing CLABSIs (IRR=0.59, 95% CI=0.45-0.77, P<0.001).
  
  
  CONCLUSIONS
  Use of an antiseptic barrier cap is associated with a lower incidence CLABSIs and is an intervention worth adding to central-line maintenance bundles.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Voor In 't Holt
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital,, Rotterdam, The Netherlands.
authors.forename: Onno K
authors.initials: OK
authors.lastname: Helder
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Margreet C
authors.initials: MC
authors.lastname: Vos
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Schafthuizen
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sülz
authors.affiliation: University Medical Center Utrecht, Wilhelmina Children's Hospital, Clinical Health Science, University Utrecht, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
authors.affiliation: Department of Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: w.ista@erasmusmc.nl.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections; D062905:Central Venous Catheters / Q000009:adverse effects*; D017046:Cost Savings; D006801:Humans
chemical_list: D000891:Anti-Infective Agents, Local
keywords: Antiseptic barrier cap; Central line-associated bloodstream infections; Infection control; Meta-analysis; Systematic review