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Schora D, Patel P, Barza R, Patel J, Wilson K, Espina-Gabriel P, Nunez V, Singh K. Positive and Neutral Needleless Connectors: A Comparative Study of Central-line Associated Bloodstream Infection, Occlusion, and Bacterial Contamination of the Connector Lumen. JOURNAL OF INFUSION NURSING 2023; 46:157-161. [PMID: 37104691 DOI: 10.1097/nan.0000000000000506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A pragmatic, multiphase prospective quality improvement initiative was performed to determine whether a positive displacement connector (PD) causes reduction of central line-associated bloodstream infection (CLABSI), occlusion, and catheter hub colonization when compared with a neutral displacement connector with alcohol disinfecting cap (AC). Patients with an active central vascular access device (CVAD) were enrolled March 2018 to February 2019 (P2) and compared to the prior year (P1). Two hospitals were randomized to use PD without AC (Hospital A) and with AC (Hospital B). Two hospitals utilized a neutral displacement connector with AC (Hospitals C and D). CVADs were monitored for CLABSI, occlusion, and bacterial contamination during P2. Of the 2454 lines in the study, 1049 were cultured. CLABSI decreased in all groups between P1 and P2: Hospital A, 13 (1.1%) to 2 (0.2%); Hospital B, 2 (0.3%) to 0; and Hospitals C and D, 5 (0.5%) to 1 (0.1%). CLABSI reduction was equivalent between P1 and P2 with and without AC, at around 86%. The rate of occlusion per lumen was 14.4%, 12.1%, and 8.5% for Hospitals A, B and C, D, respectively. Hospitals using PD had a higher rate of occlusion than those that did not (P = .003). Lumen contamination with pathogens was 1.5% for Hospitals A and B and 2.1% for Hospitals C and D (P = .38). The rate of CLABSI was reduced with both connectors, and PD reduced infections with and without the use of AC. Both connector types had low-level catheter hub colonization with significant bacteria. The lowest rates of occlusion were found in the group using neutral displacement connectors.
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Affiliation(s)
- Donna Schora
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Parul Patel
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Ruby Barza
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Jignesh Patel
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Kathleen Wilson
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Paulette Espina-Gabriel
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Vesna Nunez
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
| | - Kamaljit Singh
- Department of Laboratory Medicine and Pathology (Ms Schora and Dr Singh), Department of Infectious Disease and Microbiology Research (Mss Schora, Patel, Barza, and Drs Patel and Singh), Department of Medicine (Dr Singh), and Department of Nursing (Mss Wilson, Espina-Gabriel, and Nunez), NorthShore University HealthSystem, Evanston, Illinois; University of Chicago Pritzker School of Medicine, Chicago, Illinois (Dr Singh)
- Donna Schora, MT (ASCP), Parul Patel, MT (ASCP) , and Ruby Barza, MT (ASCP) have over 20 years of experience in clinical microbiology, and along with Jignesh Patel, PhD, have 5 to 22 years of clinical research experience. Kathleen Wilson, RN, Paulette Espina-Gabriel, RN, and Vesna Nunez, RN, are clinical nurse managers with vascular access experience and manage those teams. Kamaljit Singh, MD, has over 25 years of Infectious Disease, Infection Prevention, and Clinical Microbiology experience
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Koeppen M, Weinert F, Oehlschlaeger S, Koerner A, Rosenberger P, Haeberle HA. Needle-free connectors catheter-related bloodstream infections: a prospective randomized controlled trial. Intensive Care Med Exp 2019; 7:63. [PMID: 31792889 PMCID: PMC6888779 DOI: 10.1186/s40635-019-0277-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background In the critically ill, catheter-related bloodstream infection can result from bacterial contamination of infusion hubs of intravascular catheters. Needle-free connectors (NFC) have been suggested to reduce the rate of bacterial contamination and subsequent catheter-related bloodstream infection (CRBSI), but data remains ambiguous. Thus, we tested if a novel NFC would reduce bacterial contamination and subsequent CRBSI. Results In a prospective, randomized controlled trial, surgical ICU patients were randomized to three-way hubs closed by caps or Bionecteur® (Vygon, Inc.) of central venous catheters. Every 72 h, infusion lines were renewed and microbiological samples were taken. Bacterial growth was analyzed by blinded microbiologists. Incidence of bacterial contamination and CRSBI were assessed. Outcome parameters like length of stay on ICU and outcome were retrospectively assessed. Two thousand seven hundred patients were screened, 111 were randomized to the NFC, and 109 into the control group. Finally, 24 patients in the NFC and 23 control patients were analyzed. The majority of samples (NFC 77%; control 70%) found no bacterial growth. Coagulase-negative staphylococci were most commonly detected on CVC samples (NFC 17%; control 21%). We found CRBSI (defined as identical pathogens in blood culture and catheter line tip culture, and clinical manifestations of infection) in two control patients and one patient of the NFC group. Their length of ICU stay did not differ between groups (NFC 19 days; control 23 days). Conclusion The use of NFC does not influence the rate of bacterial contamination of infusion hubs of central venous catheters. Trial registration Clinicaltrials.gov, NCT02134769. Registered 09 May 2014.
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Affiliation(s)
- Michael Koeppen
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Franziska Weinert
- Department of Anesthesiology, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | | | - Andreas Koerner
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Helene Anna Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
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