Ethanol Lock for Prevention of Central Line-Associated Blood Stream Infections

Blood stream infections are an important complication of the use of central venous lines
(CVLs) and result in increased morbidity, mortality, and cost. Blood stream infections
related to CVLs may be the result of migration of skin organisms along the catheter tract or
introduction of organisms into the lumen of the catheter. The extraluminal route of
infection appears to be most common early after catheter insertion while the frequency of
infection acquired by the intraluminal route appears to increase the longer the catheter is
in place. Meticulous attention to best practices for insertion and the subsequent care of
the insertion site reduces infection by the extraluminal route. Adherence to good technique
for entering the line may similarly reduce infection by the intraluminal route.

Ethanol is an effective antimicrobial agent with activity against a broad spectrum of human
pathogens; including the bacteria and fungi which most commonly infect CVLs. The mechanism
of the antimicrobial activity of ethanol is attributed to the ability to denature proteins
and induced resistance to the effect of ethanol has not been reported. These features
suggest that ethanol-lock is a promising approach to the prevention of acquisition of
central line associated blood stream infections by the intraluminal route.

Although this study is done in the patient-care setting, patients are not the subject of
the study. The outcome of interest involves the development of CLABSI in patients but the
intervention is directed at the patient's central lines rather than the patient. There are
no inclusion or exclusion criteria; the determination of the line care regimen will be
determined by the bed assignment rather than any characteristics of the patient occupying
the bed.

All central line will be included in this study. Use of ethanol will be suspended whenever
the usage of the line precludes instillation of ethanol with a dwell time of al least one
hour.