The risk of microbial contamination associated with six different needle-free connectors.

BACKGROUND needle-free connectors are widely used in clinical practice. The aim of this study was to identify any differences between microbial ingress into six different connectors (three neutral-displacement, one negative-displacement and two anti-reflux connectors). METHODS each connector underwent a 7-day clinical simulation involving repeated microbial contamination of the connector's injection ports with Staphylococcus aureus followed by decontamination and then saline flushes through each connector. The simulation was designed to be a surrogate marker for the potential risk of contamination in clinical practice. RESULTS increasing numbers of S. aureus were detected in the flushes over the 7 days of sampling despite adherence to a rigorous decontamination programme. Significant differences in the number of S. aureus recovered from the saline flush of some types of connectors were also detected. Two different durations (5- and 15-second) of decontamination of the injection ports with 70% isopropyl alcohol (IPA) wipes were also investigated. There was no significant difference between the median number of S. aureus recovered in the saline flushes following a 5-second (165.5, 95% CI=93-260) or a 15-second decontamination regimen (75, 10-190). CONCLUSIONS The findings suggest that there may be differences in the risk of internal microbial contamination with different types of connectors and that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices

Prevention of catheter-related bloodstream infection in patients on hemodialysis

Central venous catheters (CVCs) are frequently used as vascular access for patients who require hemodialysis, but infectious complications remain a major clinical problem. Specifically, catheter-related bloodstream infections (CRBSIs) have an adverse effect on survival, hospitalization, mortality, and the overall cost of care in this setting. The growing number of patients who require hemodialysis, combined with an increasing number of patients who cannot use any vascular access other than a CVC, stress the importance of strategies to prevent CRBSI. Various interventions aimed at reducing the incidence of CRBSI are available, but they have not yet been integrated into evidence-based, consensus guidelines. In this Review, the results from several CVC infection prevention studies-of patients from dialysis and nondialysis settings-are combined to outline a rational approach to CRBSI prevention. Prevention of intraluminal contamination of the CVC is pivotal and of proven efficacy, as are strict aseptic CVC insertion and handling protocols, use of chlorhexidine in alcohol solutions for skin cleansing, topical application of antimicrobial ointments, and antimicrobial lock solutions. Adherence to a meticulous catheter care protocol can achieve a CRBSI incidence well below one episode per 1,000 catheter days, even without the need for antimicrobial ointments or lock solutions.</p