The effects of needleless connectors on catheter-related bloodstream infections

American Journal of Infection Control

Volumn 39, Issue 4, 2011, Pages 277-283

  Btaiche, Imad F ^a,b   Kovacevich, Debra S ^b   Khalidi, Nabil ^a   Papke, Lorelei F ^b  

^a UNIVERSITY OF MICHIGAN   (United States)

^b UNIVERSITY OF MICHIGAN HOSPITALS   (United States)

Author keywords

catheters; contamination; infection; mechanical valves; Needleless connectors

Indexed keywords

CHLORHEXIDINE; HEPARIN; SILVER NANOPARTICLE;

ARTERY CATHETER; ATS VALVE; BLOODSTREAM INFECTION; CATHETER CARE; CATHETER INFECTION; CATHETERS AND TUBES; DISINFECTION; EQUIPMENT DESIGN; HOME CARE; HUMAN; INFECTION CONTROL; INTRAVASCULAR CATHETER; LUER ACTIVATED MECHANICAL VALVE; MEDICAL INSTRUMENTATION; MICROBIAL CONTAMINATION; MULTICENTER STUDY (TOPIC); NEEDLE; NEEDLELESS CONNECTOR; NEEDLESTICK INJURY; NURSING HOME PATIENT; POSITIVE PRESSURE VALVE; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; SPLIT SEPTUM CONNECTOR; SYRINGE; VASCULAR ACCESS;

CATHETER-RELATED INFECTIONS; CATHETERIZATION; CHLORHEXIDINE; DISINFECTANTS; DISINFECTION; HUMANS; NEEDLESTICK INJURIES; SEPSIS;

EID: 79955603032     PISSN: 01966553     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ajic.2010.07.011     Document Type: Review

References (56)

1. United States General Accounting Office. Occupational safety: selected cost and benefit implication of needlestick prevention devices for hospitals. GAO-01-06R; November 17, 2000.
2. Centers for Disease Control and Prevention. Workbook for designing, implementing, and evaluating a sharps injury prevention program. February 12, 2004. Available at: http://www.cdc.gov/sharpssafety/. Accessed August 12, 2009.
3. Occupational Safety and Health Administration: final rule on occupational exposure to bloodborne pathogens. Federal Register 1991;56:48250.
4. Hadaway L, Richardson D. Needleless connectors: a primer on terminology. J Infus Nurs 2010;33:22-31.
5. Yebenes JC, Serra-Prat M. Clinical use of disinfectable needle-free connectors. Am J Infect Control 2008;36(Suppl 175):e1-4.
6. Jarvis WR, Murphy C, Hall KK, Fogle PJ, Karchmer TB, Harrington G, et al. Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis 2009;49:1821-7.
7. Mendelson MH, Short LJ, Schechter CB, Meyers BR, Rodriguez M, Cohen S, et al. Study of a needleless intermittent intravenous-access system for peripheral infusions: analysis of staff, patient, and institutional outcomes. Infect Control Hosp Epidemiol 1998;19:401-6. (Pubitemid 128474131)
8. Schilling S, Doellman D, Hutchinson N, Jacobs BR. The impact of needleless connector device design on central venous catheter occlusion in children: a prospective, controlled trial. JPEN J Parenter Enteral Nutr 2006;30:85-90. (Pubitemid 44314781)
9. Krzywda EA. Predisposing factors, prevention, and management of central venous catheter occlusions. J Intraven Nurs 1999;22(Suppl 6):S11-7.
10. Jacobs BR, Schilling S, Doellman D, Hutchinson N, Rickey M, Nelson S. Central venous catheter occlusion: a prospective, controlled trial examining the impact of a positive pressure valve device. JPEN J Parenter Enteral Nutr 2004;28:113-8. (Pubitemid 38365377)
11. Rummel MA, Donnelly PJ, Fortenbaugh CC. Clinical evaluation of a positive pressure device to prevent central venous catheter occlusion: results of a pilot study. Clin J Oncol Nurs 2001;5:261-5.
12. Berger L. The effects of positive pressure devices on catheter occlusions. JVAD Winter 2000;1-4.
13. Khalidi N, Kovacevich D, Papke-O'Donnell L, Btaiche I. Impact of the positive pressure valve on vascular access device occlusions and bloodstream infections. JAVA 2009;14:84-91.
14. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159-71. (Pubitemid 44316281)
15. Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391-402. (Pubitemid 30127778)
16. Renaud B, Brun-Buisson C. Outcomes of primary and catheter-related bacteremia: a cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 2001;163:1584-90. (Pubitemid 32578760)
17. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, DeWaele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591-8. (Pubitemid 41693760)
18. Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a non teaching hospital. Crit Care Med 2006;34:2084-9. (Pubitemid 44305609)
19. Yebenes JC, Martinez R, Serra-Prat M, Sauca G, Capdevila JA, Balanzó X, et al. Resistance to the migration of microorganisms of a needle-free disinfectable connector. Am J Infect Control 2003;31:462-4. (Pubitemid 37533213)
20. Trautmann M, Moosbauer S, Schmitz FJ. Experimental study on the safety of a new connecting device. Am J Infect Control 2004;32:296-300. (Pubitemid 38993373)
21. Yebenes JC, Delgado M, Sauca G, Serra-Prat M, Solsona M, Almirall J, et al. Efficacy of three different valve systems of needle-free closed connectors in avoiding access of microorganisms to endovascular catheters after incorrect handling. Crit Care Med 2008;36:2558-61.
22. Arduino MJ, Bland LA, Danzig LE, McAllister SK, Aguero SM. Microbiologic evaluation of needleless and needle-access devices. Am J Infect Control 1997;25:377-80. (Pubitemid 27446847)
23. Luebke MA, Arduino MJ, Duda DL, Dudar TE, McAllister SK, Bland LA, et al. Comparison of the microbial barrier properties of a needleless and a conventional needle-based intravenous access system. Am J Infect Control 1998;26:437-41. (Pubitemid 28381730)
24. Brown JD, Moss HA, Elliot TSJ. The potential for catheter microbial contamination from a needleless connector. J Hosp Infect 1997;36:181-9. (Pubitemid 27354772)
25. Menyhay SZ, Maki DG. Preventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors. Am J Infect Control 2008;36(Suppl 174):e1-5.
26. Casey AL, Worthington T, Lambert PA, Quinn D, Faroqui MH, Elliott TS. A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector. J Hosp Infect 2003;54:288-93. (Pubitemid 37554924)
27. Kaler W, Chin R. Successful disinfection of needleless access ports: a matter of time and friction. JAVA 2007;12:3-9.
28. Menyhay SZ, Maki DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006;27:23-7. (Pubitemid 46939746)
29. Maki DG. In vitro studies of a novel antimicrobial luer-activated needleless connector for prevention of catheter-related bloodstream infection. Clin Infect Dis 2010;50:1580-7.
30. Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257-66. (Pubitemid 27352045)
31. Seymour VM, Dhallu TS, Moss HA, Tebbs SE, Elliot TSJ. A prospective clinical study to investigate the microbial contamination of a needleless connector. J Hosp Infect 2000;45:165-8. (Pubitemid 30438981)
32. Bouza E, Munoz P, Lopez-Rodriguez J, Jesús Pérez M, Rincón C, Martín Rabadán P, et al. A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study. J Hosp Infect 2003;54:279-87. (Pubitemid 37554923)
33. Casey AL, Burnell S, Whinn H, Worthington T, Faroqui MH, Elliott TS. A prospective clinical trial to evaluate the microbial barrier of a needleless connector. J Hosp Infect 2007;65:212-8.
34. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:62-7. (Pubitemid 38147108)
35. Yebenes JC, Sauca G, Solsona M, Martinez R, Serra-Prat M, Gil P, et al. Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients. J Hosp Infect 2008;70:341-5.
36. Yebenes JC, Vidaur L, Serra-Prat M, Sirvent JM, Batlle J, Motje M, et al. Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: a randomized controlled trial. Am J Infect Control 2004;32:291-5. (Pubitemid 38993372)
37. Elliott TS, Curran A. Effects of heparin and chlorbutol on bacterial colonisation of intravascular cannulae in an in vitro model. J Hosp Infect 1989;14:193-200. (Pubitemid 19259975)
38. Esteve F, Pujol M, Limon E, Saballs M, Argerich MJ, Verdaguer R, et al. Bloodstream infection related to catheter connections: a prospective trial of two connection systems. J Hosp Infect 2007;67:30-4. (Pubitemid 47377725)
39. Danzig LE, Short LJ, Collins K, Mahoney M, Sepe S, Bland L, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995;273:1862-4.
40. Kellerman S, Shay DK, Howard J, Goes C, Feusner J, Rosenberg J, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices. J Pediatr 1996;129:711-7. (Pubitemid 27498281)
41. Salgado CD, Chinnes L, Paczesny TH, Cantey JR. Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital. Infect Control Hosp Epidemiol 2007;28:684-8. (Pubitemid 46954754)
42. Rupp ME, Sholtz LA, Jourdan DR, Marion ND, Tyner LK, Fey PD, et al. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clin Infect Dis 2007;44:1408-14. (Pubitemid 46801581)
43. Maragakis LL, Bradley KL, Song X, Beers C, Miller MR, Cosgrove SE, et al. Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006;27:67-70. (Pubitemid 46939753)
44. Field K, McFarlane C, Cheng AC, Hughes AJ, Jacobs E, Styles K, et al. Incidence of catheter-related bloodstream infection among patients with a needleless, mechanical valve-based intravenous connector in an Australian hematology-oncology unit. Infect Control Hosp Epidemiol 2007;28:610-3. (Pubitemid 46814555)
45. Murga R, Miller JM, Donlan RM. Biofilm formation by gram-negative bacteria on central venouscatheter connectors: effect of conditioning films in a laboratory model. J Clin Microbiol 2001;39:2294-7. (Pubitemid 32531498)
46. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 1993;168:400-7. (Pubitemid 23210618)
47. Garland JS, Alex CP, Sevallius JM, Murphy DM, Good MJ, Volberding AM, et al. Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. Infect Control Hosp Epidemiol 2008;29:243-9.
48. Cookson ST, Ihrig M, O'Mara EM, Denny M, Volk H, Banerjee SN, et al. Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol 1998;19:23-7. (Pubitemid 128472658)
49. Blake M. Update: catheter-related bloodstream infection rates in relation to clinical practice and needleless device type. Can J Infect Control 2008;23:156-60.
50. McDonald LC, Banerjee SN, Jarvis WR. Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy. Infect Control Hosp Epidemiol 1998;19:772-7. (Pubitemid 128472230)
51. Do AN, Ray BJ, Banerjee SN, Illian AF, Barnett BJ, Pham MH, et al. Bloodstream infection associated with needleless device use and the importance of infection control practices in the home health care setting. J Infect Dis 1999;179:442-8. (Pubitemid 29086647)
52. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51(RR-10):1-29.
53. Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S22-30.
54. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1-45.
55. Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999;281:261-7. (Pubitemid 29058116)
56. Ramritu P, Halton K, Collignon P, Cook D, Fraenkel D, Battistutta D, et al. A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units. Am J Infect Control 2008;36:104-17. (Pubitemid 351296068)