1.1 ClearGuard HD antimicrobial barrier caps are recommended as a cost-saving option for preventing catheter-related bloodstream infections in people with central venous catheters having haemodialysis.
1.2 Data should be collected on any long-term effect of chlorhexidine exposure, in particular in children.
Why the committee made these recommendations
ClearGuard HD caps are used with central venous catheters in haemodialysis. They are different from standard caps because they contain a rod coated in the antimicrobial chlorhexidine acetate to prevent infection. Other options for preventing infection are the Curos disinfecting cap, used with Tego needleless connectors, and antimicrobial line lock solutions.
Clinical evidence shows that using ClearGuard HD caps instead of standard caps, Tego plus Curos, or line lock solutions reduces the risk of catheter-related bloodstream infections.
Although there is not much evidence for ClearGuard HD caps in children, they are likely to have a similarly reduced risk of catheter-related bloodstream infections.
The effect of long-term exposure to chlorhexidine is not well understood, so NICE recommends collecting data on this.
Cost modelling shows that over 1 year ClearGuard HD caps are likely to be cost saving compared with standard treatments. ClearGuard HD caps are estimated to save, per person:
£351 compared with standard caps and wipes
£1,096 compared with antimicrobial line lock solution, standard caps and wipes
£568 compared with Tego needleless connector and Curos disinfecting caps.
Savings were from the lower incidence rate and associated cost of treating catheter-related bloodstream infection with ClearGuard HD caps. Therefore, ClearGuard HD caps are recommended.
By adopting this technology, the NHS in England may save around £470,000 each year. For more details, see NICE's resource impact statement and template.