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The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients

23 January 2020
Volume 29 · Issue 2



Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality.


An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection.


The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period.


A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable.


This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population.


Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events

Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events

A statistically significant reduction (65%) in CLABSI events occurred after use.

Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG

Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths yearly that are preventable and that lead to billions of dollars in additional health care costs in the United States.1 Although central lines are important in treating many medical conditions, there is an innate infection risk associated with each use (environmental, mechanical, and intrinsic). Central lines are widely used in the chest, neck, groin, or arm to give fluids, blood, and various medications. These devices can remain in place for days, weeks, or months. Frequency of use varies greatly because some patients may require lines accessed infrequently, while others may have lines accessed multiple times daily.

Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts is a common cause of health care-associated infections (HAIs) that lead to adverse patient outcomes. Dialysis patients have a much higher infection risk associated with additional complications, costs, morbidity, and mortality due to frequent contact with the medical community, multiple comorbidity issues, more frequent hospitalizations, fistula functionality, and repeated line access.

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