References

Methods for microbial needleless connector decontamination: a systematic review and meta-analysis. 2019. https://pubmed.ncbi.nlm.nih.gov/30824388/ (Accessed November 2, 2021)

Clinical impact of needle-free connector design: a systematic review of literature. 2020. https://pubmed.ncbi.nlm.nih.gov/32056487/ (Accessed November 2, 2021)

Infusion therapy standards of practice. 2016. https://pubmed.ncbi.nlm.nih.gov/27922994/ (Accessed November 2, 2021)

Guidelines for the prevention of intravascular catheter-related infections. 2011. https://pubmed.ncbi.nlm.nih.gov/21511081/ (Accessed November 2, 2021)

Needleless connector decontamination for prevention of central venous access device infection: a pilot randomized controlled trial. 2021. https://pubmed.ncbi.nlm.nih.gov/32735809/ (Accessed November 2, 2021)

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings. 2020. https://pubmed.ncbi.nlm.nih.gov/32183925/ (Accessed November 2, 2021)

Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study. 2018. https://pubmed.ncbi.nlm.nih.gov/29045648/ (Accessed November 2, 2021)

Peripheral intravenous catheter needleless connector decontamination study—randomized controlled trial. 2020. https://pubmed.ncbi.nlm.nih.gov/31928890/ (Accessed November 2, 2021)

Alcohol caps or alcohol swabs with and without chlorhexidine: an in vitro study of 648 episodes of intravenous device needleless connector decontamination. 2017. https://pubmed.ncbi.nlm.nih.gov/28137322/ (Accessed November 2, 2021)

An in vitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle-free connectors. 2018. https://pubmed.ncbi.nlm.nih.gov/29632665/ (Accessed November 2, 2021)

Vascular Access/IV

Disinfection of needleless connectors to reduce Staphylococcus aureus bacterial load

27 October 2022
Association for Vascular Access
02 October 2022
Volume 31 · Issue 19

Abstract

HIGHLIGHTS

Compare effectiveness of chemical disinfectants in reducing S. aureus.

Five disinfectants reduced the bacterial load, especially chlorhexidine solutions.

Focus on Brazilian clinical practice of needleless connector disinfection

Purpose:

This study aimed to gain further knowledge about the comparative effectiveness of chemical disinfectants in reducing the bacterial load of NCs inoculated with S. aureus.

Methods:

Disinfection of needleless connectors was undertaken in vitro against S. aureus comparing 70% isopropyl alcohol (IPA), 70% ethanol, 0.5% and 2% chlorhexidine in 70% IPA applied with gauze, and 70% IPA single-use cap (Site-Scrub®).

Results:

All disinfectants reduced the bacterial load (P<0.001), especially the chlorhexidine solutions. Mechanical friction should follow guidelines.

Conclusion:

This study found that all tested disinfectants effectively reduced the bacterial load and more clinical studies must be developed with a focus on the Brazilian clinical practice of needleless connector disinfection.

Needleless connectors (NCs) provide entry to vascular access devices for the administration of intravenous fluids, medications, blood products, and other intravenous therapies. However, due to connector design, environmental exposure, and manual manipulation, NCs can increase the risk of catheter-associated bloodstream infection (CABSI).1,2 For this reason, clinical practice guidelines such as Infusion Therapy Standards of Practice3 and Guidelines for the Prevention of Intravascular Catheter-Related Infections4 recommend NC external surface disinfection using mechanical friction before each device manipulation. Different chemical disinfectants and NC designs have been introduced to reduce NC bacterial contamination.5 A recent systematic review concluded that alcohol-impregnated single-use caps and alcoholic chlorhexidine gluconate (CHG) wipes were associated with significantly lower CABSI than 70% isopropyl alcohol (IPA) wipes.1 However, this review included no randomized controlled trials or studies evaluating many of the chemical disinfectants used in lower resource settings (eg Brazil). In Brazil, there is a difference in available products for the disinfection of NC in comparison with the USA. In the USA, all disinfectants are available in a single-use option (a wipe or swab), while in Brazil, the disinfectants used can be bulk and applied to gauze for use. There is a lack of studies that replicate techniques used for disinfection in countries such as Brazil.

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Staphylococcus aureus
Catheter-related bloodstream infection
Needleless connector
Vascular access device
Disinfection