{"entity":{"id":"idea-upgrade-masks-and-head-turn-at-port-access-infection-study","kind":"idea","name":"Masks on patient and nurse, and the head turned away, while a port is accessed: a comparison of infection rates","aka":[],"tldr":"Some hospitals ask the nurse to wear a mask, put a mask on the patient and ask the patient to turn their head away while a chemotherapy port is accessed. No national guideline read asks for this, and no study of whether it prevents port infections was found. A comparison would settle whether it should be standard or can be dropped.","summary":"The practice. Shared Health Manitoba's public clinical procedure for giving medicines and fluids through a port (P02.2, 2025) states: \"Put a procedure mask on. Place a mask on the patient, as well as any other individuals who will remain in the vicinity.\" and \"Have the patient lay supine, and turn their head away from the port.\" It applies to all ages and is written for paramedic practitioners.\n\nWhat the guidelines say. None of the guidelines read for OnCo's implanted port protocol (ESMO 2015, CDC/HICPAC 2011, SHEA/IDSA/APIC 2022, epic3 2014, NICE CG139) recommends a mask on the clinician or the patient, or the patient turning their head away, when a port is accessed, flushed or dressed. CDC/HICPAC asks for a mask as part of maximal sterile barrier precautions when a central line or PICC is inserted (Category IB), and epic3 asks for face masks where blood or body fluid may splash into the face. Whether the INS Infusion Therapy Standards address masks at port access could not be checked, because they could not be read.\n\nWhat is not known. No trial or comparative study of masks or head-turning at port access was found in the sources read, so neither the benefit nor the cost (time, masks, the patient's comfort) has been measured.","asOf":"2026-11-11","links":[{"label":"Shared Health Manitoba, P02.2: Medication and fluid administration by subcutaneous port (clinical procedure, version 2025-05-20)","url":"https://healthproviders.sharedhealthmb.ca/download/924/p-standard-clinical-procedures/42744/p02-2-medication-fluid-administration-by-subcutaneous-port.pdf"},{"label":"CDC/HICPAC, Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 (last update October 2017)","url":"https://www.cdc.gov/infection-control/media/pdfs/Guideline-BSI-H.pdf"},{"label":"SHEA, IDSA and APIC, Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update (Infect Control Hosp Epidemiol 2022)","url":"https://doi.org/10.1017/ice.2022.87"},{"label":"Loveday et al., epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England (J Hosp Infect 2014)","url":"https://doi.org/10.1016/S0195-6701(13)60012-2"}],"tags":["protocol-upgrade","upgrade:untested","evidence:insufficient"],"related":["idea-upgrade-central-line-discard-volume-in-cancer-outpatients"],"cancers":[],"sections":["chemotherapy","supportive-care"],"technologies":["implanted-ports","huber-needles-port-access","infusion-devices-vascular-access"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["central-venous-access"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-knowledge-diffusion"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Masking the clinician and the patient and turning the patient's head away during port access does not lower port-related bloodstream infection compared with hand hygiene, chlorhexidine skin and hub antisepsis and aseptic technique alone.","rationale":"A step that is common in some units and absent from every national guideline read is either a missing recommendation or an unnecessary one. A port is accessed at nearly every treatment, so either answer matters: a protective step should be everywhere, and an unnecessary one costs time and comfort at every visit.","test":"A cluster-randomised or stepped-wedge comparison across chemotherapy day units, both arms using the guideline bundle (hand hygiene, chlorhexidine in alcohol on skin and hub, aseptic technique) and one adding masks for clinician and patient with the head turned away; primary outcome port-related bloodstream infection per 1,000 port-days, with adherence to the bundle audited in both arms. The size of the comparison depends on the baseline infection rate in the units taking part, which should be measured first, for example through a registry linking port infections to each unit's access procedure.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":3},"route":"/ideas/idea-upgrade-masks-and-head-turn-at-port-access-infection-study/","neighbours":{"idea":[{"id":"idea-upgrade-central-line-discard-volume-in-cancer-outpatients","kind":"idea","name":"Test the smallest safe discard volume for blood taken from ports and PICCs in cancer outpatients","route":"/ideas/idea-upgrade-central-line-discard-volume-in-cancer-outpatients/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"implanted-ports","kind":"technology","name":"Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)","route":"/technologies/implanted-ports/"},{"id":"infusion-devices-vascular-access","kind":"technology","name":"Infusion pumps, ports, and ambulatory chemotherapy devices","route":"/technologies/infusion-devices-vascular-access/"},{"id":"huber-needles-port-access","kind":"technology","name":"Non-coring (Huber) needles for port access","route":"/technologies/huber-needles-port-access/"}],"term":[{"id":"central-venous-access","kind":"term","name":"Central venous access (port, PICC line)","route":"/terms/central-venous-access/"}],"bottleneck":[{"id":"b-knowledge-diffusion","kind":"bottleneck","name":"Knowledge reaches practice too slowly","route":"/bottlenecks/b-knowledge-diffusion/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"protocol":[{"id":"implanted-port-access-and-care","kind":"protocol","name":"Implanted port access, flushing and care in adults having cancer treatment","route":"/protocols/implanted-port-access-and-care/"}]}}