title: Comparison of a silver-coated needleless connector and a standard needleless connector for the prevention of central line-associated bloodstream infections.
abstract: OBJECTIVE
  To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating.
  
  
  METHODS
  Prospective longitudinal observation study SETTING Two 500-bed university hospitals
  
  
  METHODS
  All hospitalized adults from November 2009 to June 2011 with non-hemodialysis central lines
  
  
  METHODS
  Hospital A started with silver-coated NCs and switched to standard NCs in September 2010; hospital B started with standard NCs and switched to silver-coated NCs. The primary outcome was the difference revealed by Poisson multivariate regression in CLABSI rate using standard Centers for Disease Control and Prevention surveillance definitions. The secondary outcome was a comparison of organism-specific CLABSI rates by NC type.
  
  
  RESULTS
  Among 15,845 hospital admissions, 140,186 central-line days and 221 CLABSIs were recorded during the study period. In a multivariate model, the CLABSI rate per 1,000 central-line days was lower with silver-coated NCs than with standard NCs (1.21 vs 1.79; incidence rate ratio=0.68 [95% CI: 0.52-0.89], P=.005). A lower CLABSI rate per 1,000 central-line days for the silver-coated NCs versus the standard NCs was observed with S. aureus (0.11 vs 0.30, P=.02), enterococci (0.10 vs 0.27, P=.03), and Gram-negative organisms (0.28 vs 0.63, P=.003) but not with coagulase-negative staphylococci (0.31 vs 0.36) or Candida spp. (0.42 vs 0.40).
  
  
  CONCLUSIONS
  The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Jacob
authors.affiliation: 2Division of Hospital Medicine,Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Sheri
authors.initials: S
authors.lastname: Chernetsky Tejedor
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: Mary
authors.initials: M
authors.lastname: Dent Reyes
authors.affiliation: 4Department of Biostatistics and Bioinformatics Emory University School of Public Health,Atlanta,Georgia.
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.affiliation: 4Department of Biostatistics and Bioinformatics Emory University School of Public Health,Atlanta,Georgia.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Easley
authors.affiliation: 5Department of Epidemiology,Emory University School of Public Health,Atlanta,Georgia.
authors.forename: William L
authors.initials: WL
authors.lastname: Aurand
authors.affiliation: 3Emory Healthcare,Atlanta,Georgia.
authors.forename: Gina
authors.initials: G
authors.lastname: Garrett
authors.affiliation: 3Emory Healthcare,Atlanta,Georgia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Graham
authors.affiliation: 3Emory Healthcare,Atlanta,Georgia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Holder
authors.affiliation: 3Emory Healthcare,Atlanta,Georgia.
authors.forename: Chad
authors.initials: C
authors.lastname: Robichaux
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Emory University School of Medicine,Atlanta,Georgia.
authors.forename: James P
authors.initials: JP
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D062905:Central Venous Catheters; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011446:Prospective Studies; D012044:Regression Analysis; D012834:Silver / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004202:Disinfectants; D012834:Silver