Clinical and Economic Impact of 70% Isopropyl Alcohol–Impregnated Disinfecting Caps on CLABSI Rates in Ambulatory Pediatric Hematology-Oncology Patients

BACKGROUND: Totally implantable venous access devices are essential for long-term care in pediatric cancer patients, but they can cause catheter-associated bloodstream infections (CLABSIs). While central line bundles have proven effective in preventing CLABSIs in inpatient settings, data on adjunct prevention strategies, such as 70% isopropyl alcohol-impregnated disinfecting caps, in ambulatory pediatric oncology patients are limited. OBJECTIVE: To assess the impact of 70% isopropyl alcohol-impregnated disinfecting caps on the rate and cost of CLABSIs in ambulatory pediatric hematology-oncology patients with ports. METHODS: This study compared 2 distinct periods at an outpatient clinic: control group (n=58) and a study group using 70% isopropyl alcohol-impregnated disinfecting caps (n=34). The primary outcome was the CLABSI rate per 1000 catheter-days. Secondary outcomes included attributable health care costs and cost-effectiveness analysis. RESULTS: The CLABSI rate was 13.55/1000 catheter-days in the control group and 2.05/1000 catheter-days in the study group, reflecting an 84.9% reduction. The cost analysis demonstrated that the intervention was cost-effective, with estimated savings ranging from $2637.68 to $10,916.67 and a return on investment of up to 9.641%. CONCLUSION: Implementation of 70% isopropyl alcohol-impregnated disinfecting caps resulted in a substantial clinical reduction in ambulatory CLABSI incidence and yielded significant cost savings in this high-risk population.