Abstract
BackgroundThe optimal decontamination method for needle-free connectors is still unresolved. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors.MethodsThe injection ports of needle-free connectors were inoculated with Staphylococcus aureus and allowed to dry. Disinfection caps containing 70% (v/v) isopropyl alcohol (IPA) were attached to the connectors for one, three or 7 days and were compared with needle-free connectors cleaned with 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) IPA. The number of S. aureus remaining on the injection ports was evaluated. Median log10 reductions and 95% confidence interval (CI) were calculated and data analyzed using the Mann-Whitney test.ResultsThe application of the disinfection cap resulted in a significantly higher reduction in S. aureus than the 2% (w/v) CHG in 70% (v/v) IPA wipe, achieving a > 5 Log10 reduction in CFU at each time point.ConclusionsThe disinfection caps resulted in a significantly higher reduction in S.aureus on the injection ports when compared to the use of a 2% (w/v) CHG in 70% (v/v) IPA wipe. This offers an explanation for the lower rates of central-line associated bloodstream infection (CLABSI) associated with the use of disinfection caps reported in clinical studies.
Highlights
The optimal decontamination method for needle-free connectors is still unresolved
The Food and Drug Administration (FDA) requested that manufacturers of positive-displacement devices should conduct post-market surveillance to demonstrate that their devices were not associated with an increased risk of bloodstream infection (BSI) compared to other types of device
The aim of the study was to determine under controlled laboratory conditions whether a commercially available continuous passive disinfection cap which contains 70% (v/v) isopropyl alcohol (IPA) was as effective for microbial decontamination of two different needle-free connectors when compared to defined standard cleaning with a 2% (w/v) chlorhexidine gluconate (CHG) in 70% (v/v) IPA wipe
Summary
The optimal decontamination method for needle-free connectors is still unresolved. The objective of this study was to determine if a continuous passive disinfection cap is as effective as standard cleaning for the microbial decontamination of injection ports of two types of needle-free connectors. There have been varying reports on the rates of bloodstream infection (BSI) associated with needle-free connectors including an increase in incidence following a change from split-septum connectors to mechanical connectors [1]. The Centers for Disease Control and prevention (CDC) has subsequently recommended that when needleless systems are used, a split-septum valve may be preferred over some mechanical valves [2]. A SHEA/IDSA practice update subsequently stated that the optimal needle-free connector design for the prevention of infection was still unresolved and an assessment of risks, benefits and education was again recommended [4]. Many factors have been attributed to the level of infection risk associated with needle-free connectors and includes the efficacy of disinfection of the injection ports [5].
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