Advertisement

Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis

  • Victor Daniel Rosenthal
    Correspondence
    Address correspondence to Victor Daniel Rosenthal, MD, International Nosocomial Infection Control Consortium, 11 de Septiembre 4567, Floor 12, Apt 1201, Buenos Aires 1429, Argentina.
    Affiliations
    International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
    Search for articles by this author
Published:September 21, 2019DOI:https://doi.org/10.1016/j.ajic.2019.08.015

      Highlights

      • 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.

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      CRBSI risk was statistically higher for 3WSCs compared to NFCs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Panlilio AL
        • Orelien JG
        • Srivastava PU
        • Jagger J
        • Cohn RD
        • Cardo DM
        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
        • Hu DJ
        • Kane MA
        • Heymann DL
        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
      1. 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.

        • Danzig LE
        • Short LJ
        • Collins K
        • Mahoney M
        • Sepe S
        • Bland L
        • et al.
        Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.
        JAMA. 1995; 273: 1862-1864
        • Rupp ME
        • Sholtz LA
        • Jourdan DR
        • Marion ND
        • Tyner LK
        • Fey PD
        • et al.
        Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.
        Clin Infect Dis. 2007; 44: 1408-1414
        • Benner K
        • Lucas AJ
        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
        • Hadaway L
        • Richardson D
        Needleless connectors: a primer on terminology.
        J Infus Nurs. 2010; 33: 22-31
        • Yébenes JC
        • Serra-Prat M
        Clinical use of disinfectable needle-free connectors.
        Am J Infect Control. 2008; 36 (S175.e1-4)
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • Mulrow C
        • Gotzsche PC
        • Ioannidis JP
        • et al.
        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
        • Khalidi N
        • Kovacevich DS
        • Papke-O'Donnell LF
        • Btaiche I
        Impact of the positive pressure valve on vascular access device occlusions and bloodstream infections.
        J Assoc Vasc Access. 2009; 14: 84-91
        • Friedrich JO
        • Adhikari NKJ
        • Beyene J
        Inclusion of zero total event trials in meta-analyses maintains analytic consistency and incorporates all available data.
        BMC Med Res Methodol. 2007; 7: 5
        • Keus F
        • Wetterslev J
        • Gluud C
        • Gooszen HG
        • van Laarhoven CJ
        Robustness assessments are needed to reduce bias in meta-analyses that include zero-event randomized trials.
        Am J Gastroenterol. 2009; 104: 546-551
        • Casey AL
        • Worthington T
        • Lambert PA
        • Quinn D
        • Faroqui MH
        • Elliott TS
        A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector.
        J Hosp Infect. 2003; 54: 288-293
        • Yebenes JC
        • Vidaur L
        • Serra-Prat M
        • Sirvent JM
        • Batlle J
        • Motje M
        • et al.
        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
        • Esteve F
        • Pujol M
        • Limon E
        • Saballs M
        • Argerich MJ
        • Verdaguer R
        • et al.
        Bloodstream infection related to catheter connections: a prospective trial of two connection systems.
        J Hosp Infect. 2007; 67: 30-34
        • Casey AL
        • Spare MK
        • Worthington T
        • Faroqui MH
        • Trotter E
        • Lambert PA
        • et al.
        Needleless connectors–the way forward in the prevention of catheter-related infections?.
        J Hosp Infect. 2002; 50: 77-79
        • Yebenes JC
        • Sauca G
        • Solsona M
        • Martinez R
        • Serra-Prat M
        • Gil P
        • et al.
        Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients.
        J Hosp Infect. 2008; 70: 341-345
        • Gonzalez Lopez JL
        • Arribi Vilela A
        • Fernandez del Palacio E
        • Olivares Corral J
        • Benedicto Marti C
        • Herrera Portal P
        Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study.
        J Hosp Infect. 2014; 86: 117-126
        • Rosenthal VD
        • Udwadia FE
        • Kumar S
        • Poojary A
        • Sankar R
        • Orellano PW
        • et al.
        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
        • Royer T
        Implementing a better bundle to achieve and sustain a zero central line-associated bloodstream infection rate.
        J Infus Nurs. 2010; 33: 398-406
        • Wheeler DS
        • Giaccone M
        • Hutchinson N
        • Haygood M
        • Demmel K
        • Britto MT
        • et al.
        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
        • Tabak YP
        • Jarvis WR
        • Sun X
        • Crosby CT
        • Johannes RS
        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
        • Wallace MC
        • Macy DL
        Reduction of central line-associated bloodstream infection rates in patients in the adult intensive care unit.
        J Infus Nurs. 2016; 39: 47-55
        • Casey AL
        • Karpanen TJ
        • Nightingale P
        • Chaganti S
        • Elliott TS
        Microbiologic contamination of a positive- and a neutral- displacement needleless intravenous access device in clinical use.
        Am J Infect Control. 2016; 44: 1678-1680
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • Mulrow C
        • Gøtzsche PC
        • Ioannidis JPA
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700

      Linked Article

      • Erratum
        American Journal of Infection ControlVol. 49Issue 1
        • Preview
          In the article “Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis.” by Victor D. Rosenthal. in the March issue of the American Journal of Infection Control (2020;48(3):281-84.
        • Full-Text
        • PDF