Running head: HOW PORT CLEANSE AFFECTS INCIDENCE OF INFECTION
How Port Cleanse Affects Incidence of Infection
Sarah Shirey
Ferris State University
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HOW PORT CLEANSE AFFECTS INCIDENCE OF INFECTION
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Abstract
This paper consists of data related to the clinical question that was developed due to a specific
nursing problem. The question is: In the use of central venous catheters, how does a 3, 5, 10, 15
or 30 second port cleanse compared to no port cleanse affect the incidence of infection? Three
articles were chosen to determine if the implementation of the requirement to cleanse central
venous catheter ports was beneficial to the patients’ health or not. The articles discussed the
different lengths of time that ports are cleansed for, including not at all. While there was an
outlier article that showed no difference in cleansing or not, no matter the length of time, the
consensus was that at least 15 seconds of cleansing a port before accessing it decreased the
incidence of infection. Due to the results the policy and procedure of cleansing for 15 seconds
was proven to be a good policy that needs to be followed in the best interest of patients’ health.
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How Port Cleanse Affects Incidence of Infection
The purpose of this paper is to examine a clinical question that is based on a nursing
problem. This paper will look closely at the specific clinical problem including the methodology
used to search for evidence, a discussion of the literature reviewed and the significance to
nursing. The clinical question will be dissected and answered throughout the paper.
Clinical Question
The clinical question that was created based on a specific nursing problem was: In the use
of central venous catheters, how does a 3, 5, 10, 15 or 30 second port cleanse compared to no
port cleanse affect the incidence of infection? The required cleansing time is 15 seconds
according to many hospitals’ policies and procedures, however, some nurses do not cleanse for
that amount of time or at all, here lies the question of how does that a specific amount of
cleansing compared to no cleanse affect infection? There are some nurses that cleanse over the
required time, while that cannot necessarily hurt anything the question arises, is it necessary or is
the 15 second requirement sufficient or is no cleanse needed at all?
This is a clinical problem because it directly affects the health of patients. Central lineassociated infections can result in an increased hospital stay which causes a higher health care
cost to the patient and/or hospital and infections can lead to serious health complications or even
to death. The patients are already in the hospital for an undesired reason, if the prevention of an
additional complication can be accomplished with cleansing a port for a specific time then it
should be done and that specific amount of time should be determined.
Methodology
The Ferris State University FLITE Library SmartSearch was used. Key phrases such as,
15 second cleanse before port access, 15 hub scrub, clean port for 15 seconds, fifteen second
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alcohol scrub, scrubbing the hub/port for 15 seconds. These phrases provided hundreds of
results although there were few articles that related well to the specific topic; three good articles
were available and chosen however.
The articles chosen were only nursing research due to it being a nursing related problem,
for example, doctors and physician’s assistants aren’t responsible for cleansing and using central
venous catheters, it is a task of the nurses when they provide medication or nutrients to a patient.
Due to nurses being so involved in the problem it is best to keep the data used and the results
closely related to nursing. Therefore, nursing research is used because that is first hand data
collected from and by nurses.
There are seven different levels of evidence, the higher the level of evidence of an article
the better. A low level of evidence shows that there is a need for further research while a high
level shows that the problem has been thoroughly researched and the result is proven. Evidence
Level I includes all relevant reports and results on the specific topic while the lowest level, Level
VII is reports from committees that are said to be experts on the topic. The highest level is what
is desired because then there are many different sources and data to ensure the most accurate
results.
Discussion of Literature
Reduction in Central-line Associated Bloodstream Infections by Implementation of a
Postinsertion Care Bundle
A peer reviewed (American Journal of Infection Control) article (Guerin, et al., 2010),
written by two nurses, one doctor and one internal control professional is the focus of this
critique. The purpose of the article is to discuss “the use of a central line insertion bundle to
reduce the incidence of central line-associated bloodstream infections (CLABSIs)” (Guerin, et
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al., 2010, p. 430). The problem investigated is “CLABSIs cause substantial morbidity and incur
excess costs” due to the subject of the “increased lengths of hospital stay and costs” associated
with CLABSIs (Guerin, et al., 2010, p. 430).
The article has the ratio level of measure because there are definite numbers which start
at zero and a level 5 level of evidence due to it consisting of systematic reviews. The low level of
evidence and the literature review supports a need for the study. A paired t-test of a 10 bed
medical intensive care unit and a 13 bed surgical intensive care unit in Denver, Colorado was
completed and the results were the “implementation of central venous catheter insertion bundle
was associated with a significant reduction in CLABSIs” which answers the clinical question in
that it includes scrubbing the cap for 15 – 30 second (Guerin, et al., 2010, p. 432). The results
are consistent with findings from similar studies, however this study was different because it
consistent of a ‘bundle’ of ways to prevent infection, not just the amount of time the port is
scrubbed for.
Successful Disinfection of Needleless Access Ports: A Matter of Time and Friction
A peer-reviewed (Journal of the Association for Vascular Access) article (Kaler & Chinn,
2007), written by two authors: one has a Master in Public Health and one is a Fellow of the
American College of Physicians who dedicated this article to an RN is the focus of this critique.
The purpose of the article is to study “the disinfection effectiveness for needless access ports”
(Kaler & Chinn, 2007, p. 140). The subject is if “the design of the needleless access port or the
method used to clean it prior to the access impacts successful disinfection” (Kaler & Chinn,
2007, p. 140). The reason the problem was investigated is because “250,000 episodes of central
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venous catheter-related bloodstream infections occur annually in U.S. hospitals” (Kaler & Chinn,
2007, p. 140).
The article is a level of evidence, level 5, due to that and the literature review a need for
this study is supported. The level of measure is ratio due to the possibility of having a result of
zero, such as zero infection present. There are minimal threats to validity to skew the results
from seeming valid, the highest threat is instrumental, which is internal and it could be a threat
because the supplies for testing infection could not all be exactly the same which could vary the
results. A paired t-test was performed on 20 access ports which were disinfected for 15 seconds
each, the results, which are consistent with findings from similar studies, showed that “when
access ports are subjected to a disinfection time of 15 seconds with friction” (Kaler & Chinn,
2007, p. 141) they were effectively sterilized and therefore it answers the clinical question.
“Scrub the Hub” Cleaning Duration and Reduction in Bacterial Load on Central Venous
Catheters
A peer-reviewed (Critical Care Nursing Quarterly Journal) article (Simmons, at al., 2011)
written by one author with a Master in Public Health and two authors with Master in Science of
Nursing degrees is the focus of this critique. The subject of the article is “the effect of alcohol
disinfection duration bacterial load on catheter hubs” (Simmons, at al., 2011). The problem
investigated in this article is “central line-related bloodstream infections known to lead to
increased length of stay, increased health care costs, and increased morbidity and mortality” the
purpose is “to develop performance improvement processes surrounding the insertion and care of
these catheters” (Simmons, at al., 2011, p. 31).
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The ratio level of measure applies for this article because the results and test time are
numbers and can be zero. The article has a level 5 level of evidence because it uses many
systematic reviews, with this low level and the review of the literature a need for the study is
supported. A paired t-test with a sample of 5 sets of 50 needleless connectors provided results
that state the “level of bacterial load is not significantly different based on the duration of alcohol
disinfection,” (Simmons, at al., 2011, p. 34) that answers the clinical question by showing the
amount of time the port is cleansed doesn’t affect infection incidence. The results however are
not consistent with similar studies, this study is as if cleansing the port at all doesn’t affect
infection while most other studies show that the port being cleansed decreases infection
incidences.
Significance to Nursing
The evidence findings can be integrated into practice to sustain quality and safety of the
patients nurses care for. Many studies have been completed and proven that cleansing the port of
a central venous catheter before accessing it decreases the incidence of infection. The consensus
is that 15 seconds is sufficient, while cleansing for a greater amount of time is acceptable, less
than 15 seconds is not. The implementation of cleansing for 15 seconds improved the quality
and safety of patients by decreasing infections and adverse health complications. Continued
compliance of the 15 second cleanse requirement ensures quality and safety are sustained.\
Quality and Safety Education for Nurses (QSEN) is important and focuses on “patientcentered care, evidence-based practice, safety, teamwork and collaboration, quality improvement
and informatics” (American Association of Colleges of Nursing, 2014). It is important to
consider QSEN with this clinical problem and why the ports should be cleansed before access. It
is about the patient and their quality of care being improved, there is evidence to prove the
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benefit of the practice, and it increases the safety of the patients. If the information is provided
to the appropriate people and there is collaboration between teaching the process of cleansing the
port and what is done in practice the quality and safety of the patients will definitely be improved
and sustained.
The decision to utilize the evidence was impacted by the availability of sources that
conducted studies and proved cleansing a port for 15 seconds before access is beneficial to the
patient and their health. It is relevant to health care policy because due to the study being proven
the policy was put into place that requires nurses to cleanse the port prior to access, every time.
The American Nurses Association’s Scope and Standards of Practice include the “who, what,
where, when, why and how” (American Nurses Association, 2014) which are important to
consider with any patient and care situation. Those questions were asked when considering to
implementation of the requirement of 15 second port cleanse and the answers all lead to it being
a positive change for the benefit of the patients.
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References
American Association of Colleges of Nursing. (2014). www.aacn.nche.edu/qsen/home
American Nurses Association. (2014). www.nursingworld.org/scopeandstandardsofpractice
Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central-line associated
bloodstream infections by implementation of a postinsertion care bundle. American
Journal of Infection Control, 38(6). http://dx.doi.org/10.1016/j.ajic.2010.03.007
Kaler, W., & Chinn, R. (2007). Successful disinfection of needleless access ports: A matter of
time and friction. The Journal of the Association for Vascular Access, 12(3).
http://dx.doi.org/10.2309/java.12-3-9
Nieswiadomy, R. M. (2012). Measurement and data collection. Foundations of nursing research
(6th ed., ). Upper Saddle River, N.J.: Prentice Hall
Simmons, S., Bryson, C., & Porter, S. (2011). “Scrub the hub” cleaning duration and reduction in
bacterial load on central venous catheters. Critical Care Nursing Quarterly, 34(1).
http://dx.doi.org/10.1097/CNQ.0b013e3182048073