{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:20:25Z","timestamp":1791645625783,"version":"4.3.4"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:p>\n                    Central venous catheters (CVCs) contribute disproportionately to bloodstream infection (BSI) and, by extension, to infection-related hospitalization, mortality, and health care costs in patients undergoing dialysis. Recent product advancements may reduce BSIs, but a sufficiently powered comparative-effectiveness study is needed to facilitate evidence-based patient care decisions. In a 13-month, prospective, cluster-randomized, open-label trial, we compared BSI rates in facilities using ClearGuard HD antimicrobial barrier caps (ClearGuard group) with those in facilities using Tego hemodialysis connectors plus Curos disinfecting caps (Tego+Curos group). Forty DaVita dialysis facilities in the United States were pair-matched by BSI rate, number of patients using CVCs, and geographic location, and then cluster randomized 1:1. We enrolled all adult patients undergoing dialysis with CVCs at these facilities, except those allergic to heparin or chlorhexidine. Overall, 1671 patients participated in the study, accruing &gt;183,000 CVC-days. The study outcome was positive blood culture (PBC) rate as an indicator of BSI rate. We calculated results at the cluster level and adjusted for the facility cluster effect. During a 3-month run-in period immediately before study interventions, the groups had similar BSI rates (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.8). During the 13-month intervention period that immediately followed, the ClearGuard group had a BSI rate significantly lower than that of the Tego+Curos group (0.28 versus 0.75 PBCs per 1000 CVC-days, respectively;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    =0.001). No device-related adverse events were reported. In conclusion, compared with Tego connectors plus Curos caps, ClearGuard HD antimicrobial barrier caps significantly lowered the rate of catheter-related BSIs in patients undergoing hemodialysis using CVCs, representing an important advancement in hemodialysis patient care.\n                  <\/jats:p>","DOI":"10.1681\/asn.2017080870","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T10:50:43Z","timestamp":1519296643000},"page":"1336-1343","source":"Crossref","is-referenced-by-count":52,"title":["Cluster-Randomized Trial of Devices to Prevent Catheter-Related Bloodstream Infection"],"prefix":"10.1681","volume":"29","clinical-trial-number":[{"clinical-trial-number":"nct02593149","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Steven M.","family":"Brunelli","sequence":"first","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Van Wyck","sequence":"additional","affiliation":[{"name":"DaVita, Inc., Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levi","family":"Njord","sequence":"additional","affiliation":[{"name":"DaVita, Inc., Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Ziebol","sequence":"additional","affiliation":[{"name":"Pursuit Vascular, Inc., Maple Grove, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie E.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Pursuit Vascular, Inc., Maple Grove, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas P.","family":"Killion","sequence":"additional","affiliation":[{"name":"Pursuit Vascular, Inc., Maple Grove, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,2,22]]},"reference":[{"key":"B1-20231016","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.2215\/CJN.11411116","article-title":"National healthcare safety network (NHSN) dialysis event surveillance report for 2014.","volume":"12","author":"Nguyen","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B3-20231016","doi-asserted-by":"crossref","first-page":"e01162","DOI":"10.1128\/AAC.01162-16","article-title":"Mechanisms of increased resistance to chlorhexidine and cross-resistance to colistin following exposure of Klebsiella pneumoniae clinical isolates to chlorhexidine.","volume":"61","author":"Wand","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"B4-20231016","doi-asserted-by":"crossref","first-page":"4404","DOI":"10.1128\/AAC.02419-14","article-title":"Prevalence of chlorhexidine-resistant methicillin-resistant Staphylococcus aureus following prolonged exposure.","volume":"58","author":"Schlett","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"B5-20231016","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1053\/j.ajkd.2016.09.014","article-title":"Dialysis catheter-related bloodstream infections: A cluster-randomized trial of the ClearGuard HD antimicrobial barrier cap.","volume":"69","author":"Hymes","year":"2017","journal-title":"Am J Kidney Dis"},{"key":"B7-20231016","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2147\/IJNRD.S59937","article-title":"Use of the Tego needlefree connector is associated with reduced incidence of catheter-related bloodstream infections in hemodialysis patients.","volume":"7","author":"Brunelli","year":"2014","journal-title":"Int J Nephrol Renovasc Dis"},{"key":"B9-20231016","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.ajic.2012.01.025","article-title":"Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit.","volume":"40","author":"Sweet","year":"2012","journal-title":"Am J Infect Control"},{"key":"B10-20231016","doi-asserted-by":"crossref","first-page":"2054358116669129","DOI":"10.1177\/2054358116669129","article-title":"Hemodialysis tunneled catheter-related infections.","volume":"3","author":"Miller","year":"2016","journal-title":"Can J Kidney Health Dis"},{"key":"B11-20231016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/599376","article-title":"Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious diseases society of America.","volume":"49","author":"Mermel","year":"2009","journal-title":"Clin Infect Dis"},{"key":"B14-20231016","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1053\/j.ajkd.2007.10.038","article-title":"A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection.","volume":"51","author":"Jaffer","year":"2008","journal-title":"Am J Kidney Dis"},{"key":"B15-20231016","doi-asserted-by":"crossref","first-page":"e79417","DOI":"10.1371\/journal.pone.0079417","article-title":"Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: A systematic review and meta-analysis of randomized controlled trials.","volume":"8","author":"Liu","year":"2013","journal-title":"PLoS One"},{"key":"B16-20231016","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/CCM.0b013e318206b5a2","article-title":"A novel antimicrobial and antithrombotic lock solution for hemodialysis catheters: A multi-center, controlled, randomized trial.","volume":"39","author":"Maki","year":"2011","journal-title":"Crit Care Med"},{"key":"B17-20231016","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s40697-015-0040-2","article-title":"Benefits and harms of citrate locking solutions for hemodialysis catheters: A systematic review and meta-analysis.","volume":"2","author":"Grudzinski","year":"2015","journal-title":"Can J Kidney Health Dis"},{"key":"B18-20231016","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1111\/j.1525-1594.2012.01466.x","article-title":"A novel method for measuring catheter lock spillage: An in vitro study.","volume":"36","author":"Polaschegg","year":"2012","journal-title":"Artif Organs"},{"key":"B19-20231016","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/ndt\/gft527","article-title":"Loss of antimicrobial effect of trisodium citrate due to \u2018lock\u2019 spillage from haemodialysis catheters.","volume":"29","author":"Schilcher","year":"2014","journal-title":"Nephrol Dial Transplant"},{"key":"B20-20231016","article-title":"Postmarketing experience with Neutrolin\u00ae (taurolidine, heparin, calcium citrate) catheter lock solution in hemodialysis patients [published online ahead of print December 6, 2017].","author":"Reidenberg","journal-title":"Eur J Clin Microbiol"},{"key":"B22-20231016","doi-asserted-by":"crossref","first-page":"317","DOI":"10.5414\/CNP69317","article-title":"Cardiac arrest following injection of concentrated trisodium citrate.","volume":"69","author":"Punt","year":"2008","journal-title":"Clin Nephrol"},{"key":"B23-20231016","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1053\/j.ajkd.2009.06.037","article-title":"Embolic complications from central venous hemodialysis catheters used with hypertonic citrate locking solution.","volume":"55","author":"Willicombe","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B24-20231016","doi-asserted-by":"crossref","first-page":"2688","DOI":"10.1093\/ndt\/gfg481","article-title":"Risks related to catheter locking solutions containing concentrated citrate.","volume":"18","author":"Polaschegg","year":"2003","journal-title":"Nephrol Dial Transplant"},{"key":"B25-20231016","doi-asserted-by":"crossref","first-page":"2953","DOI":"10.1093\/ndt\/gfs048","article-title":"Trisodium citrate induced protein precipitation in haemodialysis catheters might cause pulmonary embolism.","volume":"27","author":"Schilcher","year":"2012","journal-title":"Nephrol Dial Transplant"}],"container-title":["Journal of the American Society of 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