Reducing infections from contaminated needleless connectors

Needleless connectors (NC). They’re used a thousand times a day in healthcare facilities worldwide where these small devices can have a big impact.

NCs give access to the vascular system and were originally designed to cut down on the number of needlestick injuries. These days they’re described as the microbial gatekeeper of the Vascular Access Device¹. Since their introduction, they’ve been shown to be associated with increased Catheter related blood stream infections (CR-BSI). They act as a perfect portal for microbes to get into the bloodstream with potentially devastating effect².

Small devices with big consequences

CR-BSI infections impact heavily both on patients and economics. It can mean up to 20 days of hospital stays, costing up to US$56,000 per patient³. Australian data shows on average patients stay in hospital for 16.8 days longer than those who don’t suffer this avoidable complication. In 2015–16, 4,416 cases of CR-BSI were reported in public hospitals⁴, at an additional cost of AU$34,843 per episode⁵.

What’s the right disinfectant for NCs?

Healthcare professionals seem to be confused about which is the right disinfectant, as well as when and how to use it to decontaminate NCs and reduce the risk of CR-BSI. They are resorting to guesswork which doesn’t help.

What do the guidelines say?

International guidelines exist⁶ and these show via studies that using friction is effective, as well as allowing key parts to dry.

The Infusion Nurses Society recognises that NCs are “potential sites for intraluminal microbial contamination and require strict adherence to infection prevention practices”⁷. Their advice includes the following:

• “Perform vigorous mechanical scrub for manual disinfection of the needleless connector prior to each VAD access and allow to dry”
• “Length of contact time for scrubbing and drying depends on design of needleless connectors and the properties of disinfecting agent”

In the UK, the Royal College of Nursing guidance states: “injection and access devices must be decontaminated using aseptic technique prior to accessing the device”⁸.

Other National guidance states that “all injection and access sites should be decontaminated with 2% chlorhexidine gluconate in 70% alcohol. The solution should be applied with friction and allowed to dry, immediately before and after use”⁹.

Australian guidelines also state: “Clean key parts 2% chlorhexidine/70% alcohol wipes is the application of choice”¹⁰.

Methods of decontamination have also been studied and a new paper from a Brisbane-based research team has evaluated alcohol caps and alcohol swabs with and without Chlorhexidine, concluding that the optimal method of NC decontamination is 30 seconds with CHG swabs¹¹.

Clinell 2% Chlorhexidine in 70% Alcohol Wipes offer a successful solution

Clinell 2% Chlorhexidine in 70% Alcohol Wipes are the largest available measuring 190x105 mm. The larger size, made from non-woven material, makes it easier to manipulate where it’s being used. This cuts down on the risk of contamination from the clinician’s hands or fingers and supports Aseptic Non-Touch Technique (ANTT) practices.

The wipes are TGA registered for surface disinfection of non-invasive medical devices, as well as IV Access ports (hubs & connectors) amongst other things.

The wipes come with the combined support of Clinell’s Clinical Specialist nurses for training, which helps them to be implemented successfully. As with all new practices.

Clinell 2% Chlorhexidine in 70% Alcohol Wipes offer an excellent solution for those looking to adopt evidence-based practice in needleless connector decontamination.

References

1. Curran, E.C.  Needleless connectors: the vascular access catheter’s microbial gatekeeper Journal of Infection Prevention 2016, Vol. 17(5) 234 –240
2. Do A.N., Ray B.J. et al (1999) Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. Journal of Infectious Diseases 179: 442–448.
3. Helm, R. E.  et al., Accepted but Unacceptable: Peripheral IV Catheter Failure Journal of infusion nursing 38(3):189-203 · May 2015
4. Independent Hospital Pricing Authority (AU). Activity Based Funding Admitted Patient Care 2015-16, acute admitted episodes, excluding same day)
5. Australian Commission on Safety and Quality in Health Care. HACs information kit fact sheet: Healthcare-associated infection. March 2018. Available from: https://www.safetyandquality.gov.au/wp-content/uploads/2018/03/Healthcare-associated-infection-short-clinician-fact-sheet.pdf
6. Kaler, W. and R. Chinn. Successful Disinfection of Needleless Access Ports: A Matter of Time and Friction. Journal of the Association for Vascular Access, 2007. 12(3): p. 140-142.
7. Infusion Nurses Society Infusion Therapy Standards of Practice. INS, Feb 2016
8. Royal College of Nursing Standards for infusion therapy – RCN, London 4th ed. 2016
9. Loveday, H.P., et al., epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect, 2014. 86 Suppl 1: p. S1-70.
10. NHMRC, Australian Guidelines for the Prevention and Control of Infection In Healthcare, 20 p. 85 Commonwealth of Australia
11. Flynn, J., Rickard, C. et al (2017). Alcohol caps or alcohol swabs with and without Chlorhexidine: An in vitro study of 648 episodes of intravenous device needleless connector decontamination. Infection Control & Hospital Epidemiology, 38(5), 617-619. doi:10.1017/ice.2016.330

For more information visit www.clinell.com.au

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