Introduction
Reducing central line associated bloodstream infections (CLABSI) rate to zero is the goal of every ICU. In our general ICU, CLABSI rate was ~ 6/1000 catheter days (CD) during 2012-2014. After implementation of an insertion bundle and hand hygiene improvement education the rate decreased to ~ 3/1000 CD. We hypothesized that adding passive disinfecting caps to our maintenance bundle will enable us to achieve the goal of zero CLABSI.
Method
During November 2016 we introduced 3Mᵀᴹ Curosᵀᴹ disinfecting caps for needleless connectors to our ICU, a 14 bed mixed surgical-medical unit in the largest tertiary center in Israel. We provided the team with educational material and started a surveillance program to reach 100% adherence to capping all the needleless connectors not in use. We continued to monitor CLABSI rate and evaluated the added value of the caps. To assess the decreasing trend in CLABSI rates we used the Cochran-Armitage trend test.
Results
Since December 2016 until November 2017, six cases of CLABSI were detected, while in the previous year, 11 cases were detected, reflecting CLABSI rate of 1.7/1000 CD vs. 2.6/1000 CD in the previous year. During the 4 year period from 2014-2018, a significant decrease from 5.7 to 1.7/1000 CD was noted, with approximately 9% decrease per quarter (P trend=0.003) was documented.
Discussion and  Conclusion
In our ICU, where high catheter utilization ratio is a constraint, reaching zero rate of CLABSI is a great challenge despite high adherence to catheter insertion and maintenance bundles. The passive disinfecting caps are a valuable addition to the central line maintenance bundle. Adding this single intervention led to further reduction in CLABSI rate within a year. Further follow up is needed to determine the statistical significance of this single intervention.

Addition of passive disinfecting caps for needleless connectors to existing bundle for insertion of central lines reduces central line associated bloodstream infection