title: Blood drawn through valved catheter hub connectors carries a significant risk of contamination.
abstract: Infection Control became concerned when bloodstream infection (BSI) rates increased after implementing a needleless valved hub connector. During a 21-month period three different needleless catheter hub connectors were evaluated by quantitatively culturing blood drawn through hub connectors that would have ordinarily been discarded (DBC). DBC drawn through Clearlink™ catheter hub connectors were found to be twice as likely to be positive as DBC drawn through Clave® or Q-syte™ hub connectors (P < 0.04). DBC grew pathogens 46% of the time and skin organisms 54% of the time. Patients with positive DBC were three times more likely to meet Centers for Disease Control (CDC) BSI criteria by DBC cultures than by physician-ordered blood cultures (CBC; P < 0.001). For patients growing pathogens in DBC, 64% had no CBC drawn, the average temperature was lower than for patients with pathogens in CBC (99.3 ± 1.5 ve 100.6 ± 1.9, P = 0.015), and 92% of discharged patients (11 out of 12) were not treated with an antibiotic active against the DBC pathogen. Drawing BC through a catheter hub connector carries a risk of false-positives that could increase BSI rates by up to 3-fold. Further work is necessary to evaluate this concern.
authors.affiliation: Infectious Diseases Section, Department of Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1042, USA. sherertz@wfubmc.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Sherertz
authors.forename: T B
authors.initials: TB
authors.lastname: Karchmer
authors.forename: E
authors.initials: E
authors.lastname: Palavecino
authors.forename: W
authors.initials: W
authors.lastname: Bischoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis*; D001769:Blood / Q000382:microbiology*; D057785:Catheters / Q000382:microbiology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013048:Specimen Handling / Q000379:methods*; D055815:Young Adult