- •This meta-analysis compared catheter-related bloodstream infection rates in needle-free connectors vs. three-way stopcocks.
- •Cochrane and MEDLINE were searched for randomized studies published from 01/01/2000 to 09/01/2018.
- •Catheter-related bloodstream infection risk was statistically higher with three-way stopcocks than with needle-free connectors.
Needle-free connectors (NFCs) were introduced to eliminate the use of needles in intravascular catheters, and their newest generations were designed to improve patient safety and reduce catheter-related bloodstream infection (CRBSI) risks. The aim of this meta-analysis was to compare NFCs with 3-way stopcocks (3WSCs) and their effects on CRBSI rates.
A meta-analysis was conducted using a research protocol consistent with the PRISMA statement for reporting meta-analyses. The Cochrane Database of Systematic Reviews and MEDLINE were searched for relevant randomized studies published from January 2000 to September 2018.
We identified and selected for the meta-analysis 8 studies comparing CRBSI rates (according to the Centers for Disease Control and Prevention's National Healthcare Safety Network definition) associated with NFCs utilizing negative-displacement, neutral-displacement, or positive-displacement devices with rates for 3WSCs. Relative risk was 0.53 with a 95% CI of 0.28 to 1.00, and the relative difference was –0.018 with a 95% CI of –0.039 to 0.004.
CRBSI risk was statistically higher for 3WSCs compared to NFCs.
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- Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.Infect Control Hosp Epidemiol. 2004; 25: 556-562
- Transmission of HIV, hepatitis B virus, and other bloodborne pathogens in health care settings: a review of risk factors and guidelines for prevention. World Health Organization.Bull World Health Organ. 1991; 69: 623-630
US Department of Labor. Revision to OSHA's Bloodborne Pathogens Standard. Technical background and summary. Available from: https://www.osha.gov/needlesticks/needlefact.html. Accessed April 17, 2018.
- Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.JAMA. 1995; 273: 1862-1864
- Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.Clin Infect Dis. 2007; 44: 1408-1414
- ASHP therapeutic position statement on the institutional use of 0.9% sodium chloride injection to maintain patency of peripheral indwelling intermittent infusion devices.Am J Health Syst Pharm. 2012; 69: 1252-1254
- Needleless connectors: a primer on terminology.J Infus Nurs. 2010; 33: 22-31
- Clinical use of disinfectable needle-free connectors.Am J Infect Control. 2008; 36 (S175.e1-4)
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.Ann Intern Med. 2009; 151: W65-W94
- Impact of the positive pressure valve on vascular access device occlusions and bloodstream infections.J Assoc Vasc Access. 2009; 14: 84-91
- Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data.BMC Med Res Methodol. 2007; 7: 5
- Robustness assessments are needed to reduce bias in meta-analyses that include zero-event randomized trials.Am J Gastroenterol. 2009; 104: 546-551
- A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector.J Hosp Infect. 2003; 54: 288-293
- Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: a randomized controlled trial.Am J Infect Control. 2004; 32: 291-295
- Bloodstream infection related to catheter connections: a prospective trial of two connection systems.J Hosp Infect. 2007; 67: 30-34
- Needleless connectors–the way forward in the prevention of catheter-related infections?.J Hosp Infect. 2002; 50: 77-79
- Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients.J Hosp Infect. 2008; 70: 341-345
- Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study.J Hosp Infect. 2014; 86: 117-126
- Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line-associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC).Am J Infect Control. 2015; 43: 1040-1045
- Implementing a better bundle to achieve and sustain a zero central line-associated bloodstream infection rate.J Infus Nurs. 2010; 33: 398-406
- An unexpected increase in catheter-associated bloodstream infections at a children's hospital following introduction of the Spiros closed male connector.Am J Infect Control. 2012; 40: 48-50
- Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design.Am J Infect Control. 2014; 42: 1278-1284
- Reduction of central line-associated bloodstream infection rates in patients in the adult intensive care unit.J Infus Nurs. 2016; 39: 47-55
- Microbiologic contamination of a positive- and a neutral- displacement needleless intravenous access device in clinical use.Am J Infect Control. 2016; 44: 1678-1680
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339: b2700
Published online: September 21, 2019
Conflicts of interest: None to report.
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.