Bacterial transfer and biofilm formation in needleless connectors in a clinically simulated in vitro catheter model

OBJECTIVE

Although needleless connectors (NCs) are widely used in clinical practice, they carry significant risk of bloodstream infection (BSI). In this study, we quantified differences in bacterial transfer and biofilm formation between various NCs.

DESIGN

Prospective, clinically simulated in vitro experimental study.

METHODS

We tested 20 NCs in a 5-day clinical simulation of Staphylococcus aureus inoculations onto NC septum surfaces, which were then flushed with saline and cultured for bacterial transfer. Biofilm formation was measured through destructive sampling of the connector-catheter system. Moreover, 8 NC design factors were evaluated for their influence on bacterial transfer and biofilm formation. This study was designed without a disinfection protocol to ascertain the intrinsic risk of each NC.

RESULTS

Clave Neutron and MicroClave had the lowest overall mean log density of bacteria in the flush compared to other NCs (P < .05), except there were no statistically significant differences between Clave Neutron, Microclave, SafeTouch, and SafeAccess (P ≥ .05). The amount of biofilm in the NC was positively associated with bacteria in the flush (P < .0005). Among 8 design factors, flow path was most important, with the internal cannula associated with a statistically significant 1 log reduction (LR) in bacteria in the flush (R2 = 49%) and 0.5-2 LR in the connector (R2 = 34%). All factors together best explained bacteria in the flush (R2 = 65%) and biofilm in the connector (R2 = 48%).

CONCLUSIONS

Bacterial transfer and biofilm formation in the connector-catheter system varied statistically significantly between the 20 NCs, suggesting that NC choice can lower the risk of developing catheter-related BSIs.

A review of medical devices used for safe chemotherapy applications: Focus on ONCOERA® IV GROUP products

OBJECTIVE

The healthcare workers and the workers in the manufacturing industry of chemotherapy drugs are exposed to the "hazardous" effects of these drugs during production, transportation, distribution, administration, and disposal. In order to be protected from these harmful effects, personal protective equipment and medical devices providing safe applications are used. The aim of the present article is to review of medical devices used for safe chemotherapy applications in line with the information obtained from the literature.

DATA SOURCES

The international and national reliable sources, were used in the literature review for data analysis by using the keywords including chemotherapy, chemotherapy drugs, antineoplastic drugs, cytotoxic drugs, hazardous drugs, exposure to chemotherapy drugs, side effects of chemotherapy drugs, closed-system drug transfer devices, healthcare staff, needle-free devices, needle-free connectors, surface contamination, and phthalates.

DATA SUMMARY

In order to minimize cytotoxic drug exposure, international standards were developed in the mid-1980s stating that all cytotoxic drugs should be prepared preferably in a ventilated biological safety cabinet, nurses dealing with the use of these drugs should use appropriate personal protective equipment, and in case of cytotoxic drug spillage, predefined cleaning and decontamination protocols should be followed. Although the risk of acute and long-term toxic effects in healthcare workers has decreased in recent years with these applications in the preparation and administration of cancer drugs, measurable contamination occurs in the workplace. A large number of medical devices have been developed for minimizing this type of contamination with chemotherapy drugs. In this article, these medical devices have been reviewed in detail under subtitles of closed system transfer devices, needle-free devices, and valve technology.

CONCLUSIONS

Until the results of the evaluations to be made in new studies prove the opposite, the use of these devices with additional protection measures taken, especially during the application of dangerous drugs, is of great importance in terms of patient and employee safety.

Assessment of Reflux From Needleless Connectors: Blinded Comparison of Category Designation to Benchtop Function Using a Venous Simulator

Needleless connectors (NCs) for vascular access have limited needlestick injuries, but complications including occlusion, thrombosis, and infections have increased despite reduced needlestick injuries. These complications relate to the ability of an NC design to limit volume fluctuations that can lead to fluid reflux with potential for microbial contamination. Different NC designs requiring specific usage protocols and training, a lack of clarity in NC function relative to manufacturer-designated categories, and confounding results from a limited number of studies comparing different NCs have resulted in confusion, ultimately leading to complications from undesirable fluid movement within the vascular access. The authors therefore quantified the magnitude of reflux with current commercially available NCs using a venous stimulator. Thirteen blinded NC designs spanning the categories of negative and positive displacement, neutral, and antireflux were tested to quantify fluid movement upon disconnection and reconnection from a representative intravenous pressure (3 NCs per design; 10 trials per NC). Trials for each NC tested followed consistent displacement trends leading to tight error bars. Blinded NCs were then characterized according to their function and compared with their category designation after unblinding. All positive and negative NCs functioned in a manner consistent with their respective category designations. Conversely, all NCs categorized as neutral actually functioned with negative displacement (ie, reflux upon disconnection; 4/5 NCs) or positive displacement (1/5 NCs). Only NCs classified as antireflux functioned as neutral, which was confirmed in a blinded bidirectional flow test. These results suggest that the neutral NC-marketed category may be confusing to users unless the particular NC design has an integrated antireflux component.

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

OBJECTIVES

To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter-CVC patency.

BACKGROUND

Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion.

METHODS

This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3).

RESULTS

Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%-39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection.

CONCLUSIONS

Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.

The case for using a disinfecting cap for needlefree connectors

Catheter-related bloodstream infections (CRBSIs) are a signification cause of infection. When CRBSI rates are high, the cost to the patient and the organisation can be significant. More than ever before, there is a high demand for vascular access. Advances in treatment often entail extended indwell times for central vascular access devices. The care and maintenance of these devices is crucial in avoiding complications such as infection. Using care bundles in conjunction with other simple interventions, such as passive disinfecting caps, can help reduce CRBSI rates. The published evidence demonstrates that passive disinfecting caps can help reduce infection rates associated with different types of central venous catheters by protecting needlefree connectors from colonisation by pathogens and serving as a clear indicator that the line has been disinfected.

Antisepsis in the handling of vascular access connections

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety. safety. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.