Needleless Connectors: Improving Practice, Reducing Risks

Abstract

Abstract Purpose: To assess the knowledge gap of healthcare workers about practice with needleless connectors. Background: Catheter-related bloodstream infection (CR-BSI) and lumen occlusion can be directly related to practices of cleaning needleless connectors, IV administration set management, and flushing and clamping methods. Review of Relevant Literature: Five publications report outbreaks of CR-BSI from hospitals in the US and Australia. A significant increase in CR-BSI rates after an organizational change of products was observed. No randomized controlled trials are available from the USA comparing types or designs of needleless connectors. Device instructions state some devices can be locked with normal saline. Two randomized clinical trials assessed outcomes with catheter lock solution. Both reported higher rates of occlusion with the use of normal saline only and one documented a higher rate of CR-BSI. Methods: An invitation to participate in a survey with 22 questions was sent electronically to approximately 4000 healthcare workers with a response from 554 in clinical practice. Results: The specific type of needleless connector being used was unknown by 25% and correct clamping sequence was chosen by 52.8% of respondents. The majority, 94.3% reported that they always clean these devices before each use, however there are differences in technique. Conclusions: There is a significant gap of knowledge about the specific needleless connectors being used, the most appropriate cleaning, flushing, and clamping sequence for the specific device. Implications for Practice: Staff education should focus on the connections between needleless connectors, CR-BSI and lumen occlusion. Frequent product training on needleless connectors, the specific type in use and correct techniques are necessary.