title: A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector.
abstract: The microbial contamination rate of luers of central venous catheters (CVCs) with either PosiFlow needleless connectors or standard caps attached was investigated. The efficacy of 70% (v/v) isopropyl alcohol, 0.5% (w/v) chlorhexidine in gluconate 70% (v/v) isopropyl alcohol and 10% (w/v) aqueous povidone-iodine to disinfect the intravenous connections was also assessed. Seventy-seven patients undergoing cardiac surgery who required a CVC as part of their clinical management were randomly allocated either needleless connectors or standard caps. Patients were also designated to receive chlorhexidine/alcohol, isopropyl alcohol or povidone-iodine for pre-CVC insertion skin preparation and disinfection of the connections. After 72 h in situ the microbial contamination rate of 580 luers, 306 with standard caps and 274 with needleless connectors attached, was determined. The microbial contamination rate of the external compression seals of 274 needleless connectors was also assessed to compare the efficacy of the three disinfectants. The internal surfaces of 55 out of 306 (18%) luers with standard caps were contaminated with micro-organisms, whilst only 18 out of 274 (6.6%) luers with needleless connectors were contaminated (P<0.0001). Of those needleless connectors disinfected with isopropyl alcohol, 69.2% were externally contaminated with micro-organisms compared with 30.8% disinfected with chlorhexidine/alcohol (P<0.0001) and 41.6% with povidone-iodine (P<0.0001). These results suggest that the use of needleless connectors may reduce the microbial contamination rate of CVC luers compared with the standard cap. Furthermore, disinfection of needleless connectors with either chlorhexidine/alcohol or povidone-iodine significantly reduced external microbial contamination. Both these strategies may reduce the risk of catheter-related infections acquired via the intraluminal route.
authors.affiliation: Department of Clinical Microbiology, University Hospital Birmingham NHS Trust, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Casey
authors.forename: T
authors.initials: T
authors.lastname: Worthington
authors.forename: P A
authors.initials: PA
authors.lastname: Lambert
authors.forename: D
authors.initials: D
authors.lastname: Quinn
authors.forename: M H
authors.initials: MH
authors.lastname: Faroqui
authors.forename: T S J
authors.initials: TS
authors.lastname: Elliott
mesh_terms: D019840:2-Propanol / Q000627:therapeutic use; D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D004866:Equipment Contamination / Q000517:prevention & control* / Q000706:statistics & numerical data; D004867:Equipment Design; D005260:Female; D005990:Glycerol / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use; D011446:Prospective Studies; D017592:Skin Care / Q000379:methods; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000891:Anti-Infective Agents, Local; C107060:Hydrex; D011206:Povidone-Iodine; D019840:2-Propanol; D005990:Glycerol; D002710:Chlorhexidine