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ClearGuard HD antimicrobial barrier caps for preventing haemodialysis catheter-related bloodstream infections

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2 The technology

2.1 ClearGuard HD antimicrobial barrier caps (ICU Medical) are for use with central venous catheters (CVC) in haemodialysis. The cap has a rod that extends into the CVC hub. The rod and cap threads are coated in chlorhexidine acetate, a broad-spectrum antimicrobial that aims to reduce pathogenic organisms in the CVC lock and therefore reduce the risk of catheter-related bloodstream infections (CRBSI).

Care pathway

2.2 ClearGuard HD caps are for use on CVC lines between haemodialysis sessions to reduce the risk of infections. They replace standard caps and wipes. Other options include the Curos disinfecting cap (recommended for further research by NICE) used with Tego needleless connectors, and antimicrobial line lock solutions. ClearGuard HD caps cannot be reused once removed and need to be replaced during every dialysis session. The recommended maximum use time for the cap is 3 days. The caps are not currently used in the NHS. The external assessment centre and experts do not believe that using ClearGuard HD caps would alter the current pathway and say that minimal training is needed.

Innovative aspects

2.3 ClearGuard HD caps have a coating of chlorhexidine acetate, a broad-spectrum antimicrobial agent, on the rod and cap threads. They release chlorhexidine acetate into the catheter lock solution, which remains inside the catheter hub in between treatments.

Intended use

2.4 ClearGuard HD antimicrobial caps are an alternative to standard caps, or caps and connectors, on central venous catheters, to reduce the risk of CRBSI during haemodialysis for end-stage kidney disease.

2.5 ClearGuard HD antimicrobial caps are for use by healthcare professionals trained in haemodialysis. The company and experts agree that minimal training would be needed. The caps can also be used by patients and carers doing haemodialysis at home, after they have had training in safe home haemodialysis.

Costs

2.6 ClearGuard HD caps cost £4 per pair. Haemodialysis would normally be needed 3 times a week and the caps are replaced at each dialysis session, leading to a cost of £12 a week. The company has estimated that haemodialysis patients would need a CVC for an average of 132 days (estimated by the company based on Kwak et al. 2012, Crowley et al. 2017 and Hymes et al. 2017) until a more permanent form of vascular access is established. This results in a cost of £226 per person over this period.

2.7 Clinical experts said that the 'scrub the hub' disinfection practice is likely to continue, so alongside wipes the total cost is £247 for an average of 132 days of haemodialysis.

For more details, see the website for ClearGuard HD antimicrobial barrier caps.