Forum topic

The published information about the infection rates with various types of needleless connectors is limited at present, however there are several reports available. These reports consist of the experiences of several hospitals in the US and Australia. The hospital has a documented rate of CRBSI while using one type of connector, then switch to another type and document a dramatic rise in their rates of CRBSI. These studies are all reporting a variety of product changes. One is from a negative displacement mechanical valve to a positive displacement mechanical valve. Three others have reporting changing from a split septum/blunt cannula system to a variety of mechanical valves with this same dramatic rise in CRBSI. 

What we do not have is a randomized prospective, controlled clinical trial comparing multiple types of these connectors. This would be the highest level of evidence upon which to base our judgments.

There are also several issues to be considered when assessing these reports. Were the nurses completely and consistently cleaning the connection surface before each use? Can the device be adequately cleaned? Are there uneven surfaces that prevent reaching all areas of the surface? Are there gaps in the connection surface where bugs can hide that can not be reached with an alcohol pad? What is the best agent and technique and length of time to use when cleaning these connectors? Are there differences in cleaning techniques between each type, brand or design?  

Here are the studies that I have referred to above:

1.    Maragakis L, Bradley K, Song X, 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(12):67-70.
2.    Rupp M, Sholtz L, Jourdan D, et al. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clinical Infectious Diseases. 2007;44(11):1408-1414.
3.    Field K, McFarlane C, Cheng A, 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(5):610-613.
4.    Salgado C, Chinnes L, Paczesny T, Cantey R. 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(6):684-688.

Finally, what is the condition of the administration set that is being attached to these connectors. If you are using an intermittent set for more than 24 hours, you are probably putting patients at risk for CRBSI because these sets are contaminated. Yet our focus is all on the connector. Here is another study about that issue:

1.    Hadaway L. Intermittent intravenous administration sets: Survey of current practices. Journal of American Association for Vascular Access. 2007;12(3):143-147.

Lynn