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Disinfection of Needleless Catheter Connectors and Access Ports With Alcohol May Not Prevent Microbial Entry: The Promise of a Novel Antiseptic-Barrier Cap

Published online by Cambridge University Press:  21 June 2016

Steve Z. Menyhay  and
Dennis G. Maki
Steve Z. Menyhay
Affiliation:
Menyhay Medical, Fresno, California
Dennis G. Maki*
Affiliation:
Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin
*
University of Wisconsin Hospital and Clinics, H4/574, Madison, WI 53792 ([email protected])
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Abstract

Background.

Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through the connection between the administration set and the catheter or an injection port. Most healthcare practitioners wipe the membranous septum of the needleless connector or the injection port with 70% alcohol before accessing it. We report a simulation study of the efficacy of conventional alcohol disinfection before access, compared with that of a novel antiseptic-barrier cap that, when threaded onto a needleless luer-activated valved connector, allows a chlorhexidine-impregnated sponge to come into continuous contact with the membranous surface; after removal of the cap, there is no need to disinfect the surface with alcohol before accessing it.

Methods.

One hundred five commercial, needleless luer-activated valved connectors, each accessible by a blunt male-connector luer-lock attachment, were purchased from 3 manufacturers and were tested. The membranous septum of each test device was first heavily contaminated with ~105 colony-forming units of Enterococcus faecalis and then was allowed to dry for 24 hours. Fifteen of the contaminated devices were not disinfected (positive controls), 30 were conventionally disinfected with a commercial 70% alcohol pledget, and 60 had the antiseptic cap threaded onto the connector and then removed after 10 minutes. The test connectors were then accessed with a sterile syringe containing nutrient broth media, which was injected, captured on the downstream side of the intraluminal fluid pathway, and cultured quantitatively.

Results.

All 15 control connectors (100%) showed massive transmission of microorganisms across the membranous septum (4,500-10,000 colony-forming units). Of the 30 connectors accessed after conventional disinfection with 70% alcohol, 20 (67%) showed transmission of microorganisms (442-25,000 colony-forming units). In contrast, of the 60 connectors cultured after application of the novel antiseptic cap, only 1 (1.6%) showed any transmission of microorganisms (P<.001).

Conclusions.

The findings of this study show that, if the membranous septum of a needleless luer-activated connector is heavily contaminated, conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms. In contrast, the antiseptic-barrier cap provided a high level of protection, even in the presence of very heavy contamination. This novel technology deserves to be studied in a clinical trial.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 1 , January 2006 , pp. 23 - 27
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Maki, DG, Mermel, LA. Infections due to infusion therapy. In: Bennet, JV, Brachman, PS, eds. Hospital Infections. Philadelphia: Lippincott-Raven Publishers; 1998:689–724.Google Scholar
2.Arnow, PM, Quimosing, EM, Beach, M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993; 16:778–784.CrossRefGoogle ScholarPubMed
3.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs and attributable mortality. JAMA 1994; 271:1598–1601.Google Scholar
4.Rello, J, Ochagavia, A, Sabanes, E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 2000; 162:1027–1030.CrossRefGoogle ScholarPubMed
5.Marrie, TJ, Costerton, JW. Scanning and transmission electron microscopy of in situ bacterial colonization of intravenous and intraarterial catheters. J Clin Microbiol 1984; 19:687–693.Google Scholar
6.Donlan, RM, Murga, R, Bell, M, et al. Protocol for detection of biofilms on needleless connectors attached to central venous catheters. J Clin Microbiol 2001; 39:750–753.Google Scholar
7.Murga, R, Miller, JM, Donlan, RM. Biofilm formation by gram-negative bacteria on central venous catheter connectors: effect of conditioning films in a laboratory model. J Clin Microbiol 2001; 39:2294–2297.CrossRefGoogle Scholar
8.Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwartz-Fulton, JT, Fischer, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 1982; 92:720–727.Google ScholarPubMed
9.Mermel, LA, McCormick, RD, Springman, SR, Maki, DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991; 91(Suppl 3B):197S–205S.CrossRefGoogle ScholarPubMed
10.Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with short-term noncuffed central venous catheters. Intensive Care Med 2004; 30:62–67.Google Scholar
11.Sitges-Serra, A, Puig, P, Linares, J, et al. Hub colonization as the initial step in an outbreak of catheter-related sepsis due to coagulase negative staphylococci during parenteral nutrition. JPEN J Parenter Enteral Nutr 1984; 8:668–672.Google Scholar
12.Raad, I, Costerton, W, Sabharwal, U, Sacilowski, M, Anaissie, E, Bodey, GP. Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 1993; 168:400–407.Google Scholar
13.Cheesbrough, JS, Finch, RG, Burden, RP. A prospective study of the mechanisms of infection associated with hemodialysis catheters. J Infect Dis 1986; 154:579–589.CrossRefGoogle ScholarPubMed
14.Safdar, N, Maki, DG. The risk of catheter-related bloodstream infection with peripherally-inserted central venous catheters used in the inpatient setting. Chest 2005; 128:489–495.Google Scholar
15.Tan, L, Hawk, JC III, Sterling, ML, for the Council on Scientific Affairs, American Medical Association. Report of the Council on Scientific Affairs. Preventing needlestick injuries in health care settings. Arch Intern Med 2001; 161:929–936.Google Scholar
16.Centers for Disease Control and Prevention. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 1998; 47(RR-7):1–33.Google Scholar
17.Centers for Disease Control and Prevention. Guidelines for the management of occupational exposures to hepatitis B, hepatitis C, and HIV and recommendations for postexposure prophylaxis. Atlanta: Centers for Disease Control and Prevention; 2001. Available at: http://www.cdc.gov/ncidod/dhpq/g1_occupational.html. Accessed December 13, 2005.Google Scholar
18.Danzig, LE, Short, LJ, Collins, K, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995; 273:1862–1864.CrossRefGoogle ScholarPubMed
19.Kellerman, S, Shay, DK, Howard, J, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices. J Pediatr 1996; 129:711–717.CrossRefGoogle Scholar
20.Cookson, ST, Ihrig, M, O'Mara, EM, et al. Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of needleless device. Infect Control Hosp Epidemiol 1998; 19:23–27.Google Scholar
21.McDonald, LC, Banerjee, SN, Jarvis, WR. Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy. Infect Control Hosp Epidemiol 1998; 19:772–777.Google Scholar
22.Do, AN, Ray, BJ, Banerjee, SN, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis 1999; 179:442–448.CrossRefGoogle ScholarPubMed
23.Jarvis, WR. Needleless devices and BSIs. In: Program and abstracts of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (Los Angeles). Alexandria, VA: Society for Healthcare Epidemiology of America; 2005.Google Scholar
24.Maragakis, LL, Bradley, KL, 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; 27:67–70 (in this issue).CrossRefGoogle ScholarPubMed
25.Salzman, MB, Isenberg, HD, Rubin, LG. Use of disinfectants to reduce microbial contamination of hubs of vascular catheters. J Clin Microbiol 1993; 31:475–479.CrossRefGoogle ScholarPubMed
26.Arduino, MJ, Bland, LA, Danzig, LE, et al. Microbiologic evaluation of needleless and needle-access devices. Am J Infect Control 1997; 25:377–380.CrossRefGoogle ScholarPubMed
27.Luebke, MA, Arduino, MJ, Duda, DL, et al. Comparison of the microbial barrier properties of a needleless and conventional needle-based intravenous access system. Am J Infect Control 1998; 26:437–441.Google Scholar
28.O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51(RR-10):1–29.Google ScholarPubMed
29.Halpin, DP, O'Byrne, P, McEntee, G, Hennessy, TP, Stephens, RB. Effect of a betadine connection shield on central venous catheter sepsis. Nutrition 1991; 7:33–34.Google Scholar
30.Stotter, AT, Ward, H, Waterfield, AH, Hilton, J, Sim, AJ. Junctional care: the key to prevention of catheter sepsis in intravenous feeding. JPEN J Parenter Enteral Nutr 1987; 11:159–162.Google Scholar
31.Inoue, Y, Nezu, R, Matsuda, H, et al. Experimental study of hub contamination: effect of a new connection device, the I system. JPEN J Parenter Enteral Nutr 1992; 16:178–180.Google Scholar
32.Segura, M, Alvarez-Lerma, F, Tellado, JM, et al. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg 1996; 223:363–369.CrossRefGoogle ScholarPubMed
33.Crnich, CJ, Maki, DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 2002; 34:1232–1242.CrossRefGoogle ScholarPubMed
34.Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomised trial of povidone-iodine, alcohol, and Chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991; 338:339–343.Google Scholar
35.Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002; 136:792–801.CrossRefGoogle ScholarPubMed