title: Stopcock lumen contamination does not reflect the full burden of bacterial intravenous tubing contamination: analysis using a novel injection port.
abstract: BACKGROUND
  Prior clinical studies have used injection port lumen culture as a marker of intravenous (IV) fluid system contamination. We hypothesized that culturing injected saline (effluent) is a more sensitive method of detecting IV fluid system bacterial contamination than lumen culture. To test this hypothesis, we compared the incidence of lumen contamination with effluent contamination in a simulated setting. We also measured the effect of a novel injection port protective device (Port Guide; Matrix Tooling, Inc, Wood Dale, IL) on contamination.
  
  
  METHODS
  In this ex vivo study, 33 providers performed 5 injections of 1 mL sterile saline into each of 4 injection port designs: (1) stopcock, (2) stopcock with Port Guide, (3) stopcock with disinfectable needleless closed connector (DNCC), and (4) stopcock with DNCC and Port Guide. The primary outcome was the rate of effluent contamination with simultaneously contaminated injection port lumen.
  
  
  RESULTS
  Bacterial organisms were recovered from the effluent in 17 of the 132 injection ports evaluated. Of those 17 injection ports with contaminated effluent, 4 injection port lumens were simultaneously contaminated (24%). Additionally, use of the stopcock with Port Guide significantly reduced effluent contamination.
  
  
  CONCLUSIONS
  Effluent culture is a more sensitive marker of IV fluid system contamination than injection port lumen culture. A novel protective device on the stopcock (Port Guide) significantly reduced IV fluid system bacterial contamination.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. matthew.muffly@hitchcock.org
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Muffly
authors.forename: Michael L
authors.initials: ML
authors.lastname: Beach
authors.forename: Yi Cai Isaac
authors.initials: YC
authors.lastname: Tong
authors.forename: Mark P
authors.initials: MP
authors.lastname: Yeager
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D001431:Bacteriological Techniques / Q000379:methods*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D057785:Catheters / Q000382:microbiology*; D006801:Humans; D012680:Sensitivity and Specificity