Association of catheter-related blood stream infections and aseptic technique(s) used in administration of parenteral nutrition: a systematic review and narrative synthesis

Background: Patients receiving parenteral nutrition (PN) are often thought to be at higher risk of catheter-related blood stream infections (CRBSIs) than patients receiving other infusions. Nursing practice in the administration of PN has focused on traditional aseptic/sterile techniques using sterile gloves because of this perceived risk. Aims: To identify the evidence base for current aseptic practice in the administration of PN and association with incidence of CRBSI. Methods: A systematic review was conducted. MEDLINE, EMBASE, CINAHL Plus, and Cochrane Library databases were searched for studies reporting aseptic technique used/taught in administration of PN. Results: Thirty-nine papers were identified. After title, abstract, and full text screening six studies were included. All studies were low-quality evidence, observational or quasi-experimental designs; no relevant controlled trials were identified. Evidence did not support the use of any one aseptic technique when administering PN. A structured approach to education and standardisation appeared to improve technique and reduce CRBSI. Use of sterile gloves versus non-sterile gloves did not appear to impact on CRBSI. Conclusions: There is no evidence to support the use of aseptic/sterile technique over other techniques in nurse administration of PN. However, there is a need for higher quality research in this area.