OBJECTIVES: To determine the effectiveness and cost implications of using antiseptic passive disinfecting caps (disinfecting alcohol-containing cap that twists onto needle free connector intravenous access devices) as an adjunct to standard care in patients with central or peripheral lines in a NHS hospital setting compared with standard care alone.

METHODS: A systematic review identified studies reporting on the use of antiseptic barrier caps for the reduction of central and peripheral line associated infections. Studies reporting on central line associated bloodstream infections (CLABSI) in general hospital patients and patients in an intensive care setting were pooled using meta-analysis to calculate incidence rate ratios (IRR). A decision-analytic model estimated the costs and consequences associated with the use of an antiseptic barrier cap in these groups of patients from a UK NHS perspective, using the IRRs. Other parameter inputs were obtained from published literature using UK specific sources where possible. Deterministic sensitivity analyses (DSA) and probabilistic sensitivity analyses (PSA) were conducted to assess the robustness of results.

RESULTS: The meta-analyses produced IRRs in favour of the passive disinfecting cap of 0.43 (95% CI 0.22, 0.82) in general hospital patients and 0.29 (95% CI 0.09, 0.97) in intensive care patients. The adjunctive use of the passive disinfecting cap dominated standard care alone in both settings in the economic model, as it was both cost saving and reduced the number of CLABSIs. DSA indicated these results were robust to changes in individual input parameters, and PSA estimated the results to be cost saving in 96.4% of iterations in the general hospital setting and 86.3% in the intensive care setting.

CONCLUSIONS: Based on currently available evidence, the analyses suggest that using passive disinfecting caps to protect needle free connector intravenous access devices is a cost-effective use of resources for patients with central or peripheral line catheters in the UK NHS.