RE: Needless Connectors & CRBSI

[Marilyn Hanchett]

Well, there is some evidence but it is certainly not conclusive. As Dr Marcia Ryder and I discussed in detail during our lecture at AVA, all types of devices have the potential for infection. Biofilm can and does accumulate rapidly on the inside of devices into which microorganisms are introduced. Fortunately, new research is in progress that should shed more light on the pathogenesis of these types of infections. This information will most likely be available later in 2006.   Meanwhile, we should reflect back on the evolution of these products. In the 1990s, when split septum technology dominated the market, there were concerns & reports - similar to the current controversy - that implicated split septum connectors with infection. (At that time, and somewhat ironically in retrospect, the company I was with was refusing to convert to a split septum needleless system because they claimed such products increased infection) In fact, I published an article back in 1999 in JIN that summarized what was, at the time, the current understanding regarding the use of these products. The conclusions of the 1990s were that user error and infrequent change were the primary causes of the problems reported.   Since then, luer technology in needleless connectors was developed and has replaced split septum as the dominant device type.. Now with that technology we are again hearing reports of infection. There is insufficient evidence to know conclusively whether user error, including infrequent change, incomplete or absent surface disinfection, inadequate flushing etc are implicated and, if so, to what extent. But it seems logical to me that 1) based on our experiences of the 1990s and 2) current studies that indicate the user compliance with surface disinfection is often far less than 100%, we need to evaluate this aspect more carefully - and at least consider that even if it is not a primary cause (as yet unknown), it could well be an important contributing variable in the infection equation.   While there is evidence that some facilities have reported problems, there is insufficient evidence to claim that split septum design is safer and/or that user error/procedural noncompliance can be discounted. Both Drs Maki and Jarvis have repeatedly stated in their lectures that more studies are needed before this controversy can be satisfactorily resolved.   M Hanchett RN IgG America -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Chris Cavanaugh Sent: Tuesday, January 17, 2006 6:37 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: RE: Needless Connectors & CRBSI Sorry, just have to jump in on this one, my impressions from what I heard at AVA was that there IS evidence.  Facilities that used mechanical valve adaptors saw their CRBSI go up, and returned to lower numbers after they returned to split septum systems.  That was the jist of both Dr. Maki and Jarvis’s statements.  The manufactures like to spread the ‘clinician care’ angle, but that does not seem possible when it is so many facilities having the same problem.  The reality is that germs get stuck in the plunger of some devices, probably not all.  And, when we flush these devices the germs get flushed into the catheter.  This does not happen with a split septum system.  There is an easy way to tell if your particular  brand of mechanical valve is guilty of this---Bug Glo.   Drop some Bug GLO on your valve, swab vigorously with alcohol, assuming best practice, then look at your valve.   Does it still show bug glo or did you get it all off? No manufacture will allow data to be published stating their valve causes infections, and this is a lot faster, and safer than a study.   Of course, if you have not seen CRBSIs go up in your institution, it may not be a problem for you—you may be using one of the good devices.  If so, THAT should be published.   Good luck to all----this is a surprising conclusion.  We went needleless for safety, then to mechanical valves for either positive pressure (a myth) to prevent occlusions or for luer lock access, never thinking it would lead to another problem, a much more dangerous problem like increased CRBSIs.   I think what this does show to all of us is that the latest and greatest technology may not be…..   Chris Cavanaugh, CRNI From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of [EMAIL PROTECTED] Sent: Monday, January 16, 2006 11:04 PM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: Re: Needless Connectors & CRBSI   Well Peter you hit the question exactly. Drs Maki and Jarvis did not mention a specific brand. The word from valve manufacturers seems to be blaming weaknesses in the fluid path seal that allow liquid contaminates in. I heard practioners talking about poor staff education and/or compliance with swabbing as a possible cause.   But truly we don't know that there is a problem. There was no data given as to type of valve or how it was used or how staff was educated. There was no data about a trailing a different valve to see if there was a difference. and no mention was made as to the reeducation of staff and a trail to follow that.   So I feel we have many more questions to answer before we start tossing our valves in the can. But certainly it is interesting and worthy of note. I hope that everyone will begin taking a close look at the numbers in their facilities. Perhaps a few quick small trials to see if any trends emerge.   Tony   In a message dated 1/15/2006 8:14:56 P.M. Central Standard Time, [EMAIL PROTECTED] writes: Thank you Tony for keeping us all up to date with the conference!! A question though is burning in my mind. I don't recall, from the disscussion we had on the list this spring/summer, about a brand  specific needless connector being responsible for for the increase in CRBSI. So could you please tell us which connector(s) are in question? What is the reason that belies a particular valve design, that makes it prone to causing CRBSI?   Peter Marino RN BSN   ----- Original Message ----- From: [EMAIL PROTECTED] Date: Sunday, January 15, 2006 12:06 am Subject: AVA conference, DAY 3"The topic was needleless connectors. They discussed the qualities of a needleless device that would contribute to maintaining a safe fluid pathway. The premise is that the association of increased catheter related infections with valves is likely a brand specific problem and not a wholesale problem of the device category as Drs Maki and Jarvis’s data might have led one to believe." > Tony West, RN, CRNI > Healix, Inc. > Email:  [EMAIL PROTECTED] or [EMAIL PROTECTED] > SMS: [EMAIL PROTECTED] > Cell:  214-674-4848