title: Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design.
abstract: BACKGROUND
  Intravenous needleless connectors (NCs) with a desired patient safety design may facilitate effective intravenous line care and reduce the risk for central line-associated bloodstream infection (CLA-BSI). We conducted a meta-analysis to determine the risk for CLA-BSI associated with the use of a new NC with an improved engineering design.
  
  
  METHODS
  We reviewed MEDLINE, Cochrane Database of Systematic Reviews, Embase, ClinicalTrials.gov, and studies presented in 2010-2012 at infection control and infectious diseases meetings. Studies reporting the CLA-BSIs in patients using the positive-displacement NC (study NC) compared with negative- or neutral-displacement NCs were analyzed. We estimated the relative risk of CLA-BSIs with the study NC for the pooled effect using the random effects method.
  
  
  RESULTS
  Seven studies met the inclusion criteria: 4 were conducted in intensive care units, 1 in a home health setting, and 2 in long-term acute care settings. In the comparator period, total central venous line (CL) days were 111,255; the CLA-BSI rate was 1.5 events per 1,000 CL days. In the study NC period, total CL days were 95,383; the CLA-BSI rate was 0.5 events per 1,000 CL days. The pooled CLA-BSI relative risk associated with the study NC was 0.37 (95% confidence interval, 0.16-0.90).
  
  
  CONCLUSIONS
  The NC with an improved engineering design is associated with lower CLA-BSI risk.
authors.affiliation: Department of Clinical Research, CareFusion, San Diego, CA. Electronic address: ying.tabak@carefusion.com.
authors.forename: Ying P
authors.initials: YP
authors.lastname: Tabak
authors.affiliation: Jason and Jarvis Associates, LLC, Hilton Head Island, SC.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarvis
authors.affiliation: Department of Clinical Research, CareFusion, San Diego, CA.
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Clinical Research, CareFusion, San Diego, CA.
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Crosby
authors.affiliation: Department of Clinical Research, CareFusion, San Diego, CA; Division of Gastroenterology/Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Johannes
mesh_terms: D016470:Bacteremia / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000295:instrumentation*; D007362:Intensive Care Units; D008134:Long-Term Care; D012306:Risk
keywords: Bloodstream infection; Central line–associated bloodstream infection; Meta-analysis; Needleless connector; Positive-displacement valve