title: Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.
abstract: BACKGROUND
  Needleless intravascular catheter connector valves have been introduced into clinical practice to minimize the risk of needlestick injury. However, infection-control risks associated with these valves may be underappreciated. In March 2005, a dramatic increase in bloodstream infections was noted in multiple patient care units of a hospital in temporal association with the introduction of a needleless valve into use.
  
  
  METHODS
  Surveillance for primary bloodstream infection was conducted using standard methods throughout the hospital. Blood culture contamination rates were monitored. Cultures were performed using samples obtained from intravascular catheter connector valves.
  
  
  RESULTS
  The relative risk of bloodstream infection for the time period in which the suspect connector valve was in use, compared with baseline, was 2.79 (95% confidence interval, 2.27-3.43). In critical care units, the rate of primary bloodstream infection increased with the introduction of the valve from 3.87 infections per 1000 catheter-days to 10.64 infections per 1000 catheter-days (P<.001), and it decreased to 5.59 infections per 1000 catheter-days (P=.02) in the 6 months following removal of the device from use. Similarly, in inpatient nursing units, the rate of bloodstream infection increased from 3.47 infections per 1000 catheter-days to 7.3 infections per 1000 catheter-days (P=.02) following introduction of the device, and it decreased to 2.88 infections per 1000 catheter-days (P=.57) following removal of the device from use. Similar events occurred in the cooperative care units. The rate of blood culture contamination did not substantially change over the course of the study. Of 37 valves that were subjected to microbiological sample testing, 24.3% yielded microbes, predominantly coagulase-negative staphylococci.
  
  
  CONCLUSIONS
  A significant association between primary bloodstream infection and a needleless connector valve was observed. Evaluation of needleless connector valves should include a thorough assessment of infection risks in prospective randomized trials prior to their introduction to the market.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, USA. merupp@unmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.forename: Lee A
authors.initials: LA
authors.lastname: Sholtz
authors.forename: Dawn R
authors.initials: DR
authors.lastname: Jourdan
authors.forename: Nedra D
authors.initials: ND
authors.lastname: Marion
authors.forename: Laura K
authors.initials: LK
authors.lastname: Tyner
authors.forename: Paul D
authors.initials: PD
authors.lastname: Fey
authors.forename: Peter C
authors.initials: PC
authors.lastname: Iwen
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology*; D002404:Catheterization / Q000295:instrumentation*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D006801:Humans; D012307:Risk Factors