A prospective clinical trial to evaluate the microbial barrier of a needleless connector.

Needleless connectors are being increasingly used for direct access to intravascular catheters. However, the potential for microbial contamination of these devices and subsequent infection risk is still widely debated. In this study the microbial contamination rate associated with three-way stopcock luers with standard caps attached was compared to those with Y-type extension set luers with Clearlink needleless connectors attached. Fifty patients undergoing cardiothoracic surgery who required a central venous catheter (CVC) as part of their peri- and postoperative management were studied for microbial contamination of CVC luers following 72 hrs in situ. Each patient's CVC was randomly designated to have either the three-way stopcocks with caps (control patients) or Clearlink Y-type extension sets (test patients). Prior to, and following each manipulation of the three-way stopcock luers or Clearlink devices, a 70% (v/v) isopropyl alcohol swab was used for disinfection of the connections. The microbial contamination of 393 luers, 200 with standard caps and 193 with Clearlink attached, was determined. The internal surfaces of 20 of 200 (10%) three-way stopcock luers with standard caps were contaminated with micro-organisms whereas only one of 193 (0.5%) luers with Clearlink attached was contaminated (P<0.0001). These results demonstrate that the use of the Clearlink device with a dedicated disinfection regimen reduces the internal microbial contamination rate of CVC luers compared with standard caps. The use of such needle-free devices may therefore reduce the intraluminal risk of catheter-related bloodstream infection and thereby supplement current preventive guidelines.

Incorporating microfabrication in diagnostic instruments.

As new medical diagnostics are being developed, a new and more flexible approach to microfabrication is required to support the product development cycle. This article reviews some factors that have proved useful in the successful incorporation of microfabrication.

Ramping up to volume manufacture.

In the competitive market place, failure to keep up with market demands threatens revenues and even market share. Decisions and products need to be made quickly. High volume manufacture may be the next step. The issues involved in making this decision are identified here, together with a technique to employ, which uses lateral-flow strips as an example.

WESTERN DOMICILIARY CARE SERVICE: A report on the development and activities of a home care service associated with a teaching hospital.

Following the decision of the South Australian State Government to take advantage of the Commonwealth Home Care and Paramedical Services Acts of 1969, a detailed and co-ordinated plan for a pilot scheme was offered to the Director General of Medical Services for submission to the State and Commonwealth Governments for acceptance. Approval of the scheme was obtained late in 1970 and this was followed by the appointment of a committee to be responsible for the structuring and admistration of the scheme.