Clinical use of disinfectable needle-free connectors.

BACKGROUND: In 1992, the United States Food and Drug Administration required health care services to adopt needle-free devices to prevent health care workers' exposure to bloodborne pathogens resulting from needlestick injuries, and several systems of disinfectable needle-free connectors (DNC) were introduced. STUDIES: MICROBIAL COLONIZATION: Experimental studies showed that DNCs designed with a split septum (SS-DNCs) and mechanical valve systems (MLV-DNC) prevented endoluminal colonization as effectively as needles or conventional caps. A comparison of the microbiologic barrier effect of SS-DNCs, MLV-DNCs, and passive positive-pressure (PPV)-DNCs found that PPV-DNCs were least effective in providing protection under experimental conditions of poor handling practices and high microorganism concentrations. PREVENTION OF CATHETER-RELATED BLOODSTREAM INFECTIONS: Some randomized trials show a positive or neutral effect of DNC use on the prevention of catheter-related bloodstream infections (CR-BSIs); however, some investigators have reported outbreaks of CR-BSIs following the introductions of DNCs that could be related to noncompliance with DNC handling recommendations or the use of PPV-DNCs. CONCLUSION: Strategies focused in the implication of the nurse staff in CRBSI surveillance increase compliance with DNC handling recommendations and minimize the risk of developing a CR-BSI. DNCs can be used safely if staff complies with recommendations for use.