Hostname: page-component-6766d58669-h8lrw Total loading time: 0 Render date: 2026-05-18T09:02:46.261Z Has data issue: false hasContentIssue false
  • English
  • Français

Adequate Disinfection of a Split-Septum Needleless Intravascular Connector with a 5-Second Alcohol Scrub

Published online by Cambridge University Press:  02 January 2015

Mark E. Rupp ,
Stephanie Yu ,
Tomas Huerta ,
R. Jennifer Cavalieri ,
Roxanne Alter ,
Paul D. Fey ,
Trevor Van Schooneveld  and
James R. Anderson
Mark E. Rupp*
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Infection Control and Epidemiology, Nebraska Medical Center, Omaha, Nebraska
Stephanie Yu
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Tomas Huerta
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
R. Jennifer Cavalieri
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Roxanne Alter
Affiliation:
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
Paul D. Fey
Affiliation:
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
Trevor Van Schooneveld
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Infection Control and Epidemiology, Nebraska Medical Center, Omaha, Nebraska
James R. Anderson
Affiliation:
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
*
984031 Nebraska Medical Center, Omaha, NE 68198 (merupp@unmc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Define optimum vascular catheter connector valve disinfection practices under laboratory and clinical conditions.

Design.

Prospective observational clinical survey and laboratory assessment of disinfection procedures.

Setting.

All adult inpatients at an academic healthcare center.

Methods.

In the clinical setting, contamination of needleless connectors was assessed in 6 weekly prevalence surveys in which the connector valves from central venous catheters (CVCs) in situ were cultured by pressing the connector diaphragm to an agar plate. Before culture, valves were disinfected by scrubbing the diaphragm with a 70% isopropyl alcohol pledget for 0, 5, 10, 15, or 30 seconds. In the laboratory, the diaphragms on 150 unused sterile connector valves were inoculated with 103, 105, or 108 colony-forming units of Staphylococcus epidermidis and allowed to dry. After disinfection of the diaphragms by scrubbing with a 70% isopropyl alcohol pledget for 0, 5, 10, 15, or 30 seconds, the valves were sampled by pressing the diaphragm to an agar plate.

Results.

In the clinical setting, 363 connector valves from patients with CVCs were sampled, and 66.7% of nondisinfected valves revealed bacterial contamination. After 5-second disinfection with an alcohol pledget, only 1 (1.4%) of 71 yielded microbial growth (P < .005). In the laboratory, at the 103 and 105 inoculum, all connector valves yielded sterile cultures when scrubbed for 5 or more seconds (P < .001). At the 108 inoculum, 2 (20%) of 10 connector valves yielded minimal growth of S. epidermidis.

Conclusions.

A 5-second scrub with a 70% isopropyl alcohol pledget yields adequate disinfection of a split-septum intravascular catheter connector valve under clinical and laboratory conditions.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 7 , July 2012 , pp. 661 - 665
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Rupp, ME, Sholtz, LA, Jourdan, DR, et al. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. Clin Infect Dis 2007;44:1408–1414.Google Scholar
2. Maragakis, LL, Bradley, KL, Song, X, et al. Increased catheter-related bloodstream infection rates after the introduction a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006;27:67–70.Google Scholar
3. Jarvis, WR, Murphy, C, Hall, KK, et al. Healthcare-associated bloodstream infections associated with negative or positive pressure/displacement mechanical valve needleless connectors. Clin Infect Dis 2009;49:1821–1827.CrossRefGoogle Scholar
4. Hewlett, A, Rupp, ME. Infections related to the use of intravascular devices inserted for short-term vascular access. Chapter 17. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2012:241–247.Google Scholar
5. Centers for Medicare and Medicaid Services. Hospital-acquired conditions. http://www.cms.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp. Accessed December 15, 2011.Google Scholar
6. McKibben, L, Horan, T, Tokars, JI, et al. Guidance on public reporting of healthcare-associated infections: recommendations of the healthcare infection control practices advisory committee. Am J Infect Control 2005;33:217–226.CrossRefGoogle ScholarPubMed
7. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:1087–1099.Google Scholar
8. Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs 2011;34(1S):S1–S110.Google Scholar
9. Menyhay, SZ, Maki, DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006;27:23–27.CrossRefGoogle Scholar
10. Rupp, ME, Ulphani, JS, Fey, PD, Mack, D. Characterization of Staphylococcus epidermidis polysaccharide intercellular adhesion/hemagglutinin in the pathogenesis of intravascular catheter-associated infection in a rat model. Infect Immun 1999;67: 2656–2659.Google Scholar
11. Needlestick safety and prevention act. Public law 106-430. 106th Congress. http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname = 106_cong_public_laws&docid = f:publ430.106. Accessed December 12, 2011.Google Scholar
12. United States Food and Drug Administration. Letter to infection control practitioners regarding positive displacement needleless connectors. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm220459.htm#a. Accessed December 15, 2011.Google Scholar
13. Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60: 243–248.Google Scholar
14. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
15. Donlan, RM, Murga, R, Bell, M, et al. Protocol for detection of biofilms on needleless connectors attached to central venous catheters. J Clin Microbiol 2001;39:750–753.Google Scholar
16. Sherertz, RJ, Karchmer, TB, Palavecino, E, Bischoff, W. Blood drawn through valved catheter hub connectors carries a significant risk of contamination. Eur J Clin Microbiol Infect Dis 2011; 30:1571–1577.Google Scholar
17. Seymour, VM, Dhallu, TS, Moss, HA, Tebbs, SE, Elliott, TSJ. A prospective clinical study to investigate the microbial contamination of a needleless connector. J Hosp Infect 2000;45:165–168.Google Scholar
18. National Association of Children's Hospitals and Related Institutions. PICU collaborative resource guide and tool templates. http://www.childrenshospitalsnet/AM.Template.cfm?section = Home3&Template =/customSource/homepage/home.cfm. Accessed December 15, 2011.Google Scholar
19. Casey, AL, Worthington, T, Lambert, PA, Quinn, D, Faroqui, MH, Elliott, TSJ. A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector. J Hosp Infect 2003;54:288–293.Google Scholar
20. Btaiche, IF, Kovacevich, DS, Khalidi, N, Papke, LF. The effects of needleless connectors on catheter-related bloodstream infections. Am J Infect Control 2011;39:277–283.Google Scholar
21. Soofhill, JS, Bravery, K, Ho, A, et al. A fall in bloodstream infections following a change to 2% Chlorhexidine in 70% iso-propanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward. Am J Infect Control 2009;37:626–630.Google Scholar
22. Rupp, ME, Fey, PD. Staphylococcus epidermidis and other coag-ulase-negative staphylococci. Chapter 196. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 7th ed. New York: Elsevier/Churchill Livingstone, 2010: 2579–2589.Google Scholar
23. Ali, Y, Donlan, MJ, Fendler, EJ, Larson, EL. Alcohols. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2001:229–254.Google Scholar