Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap
Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: The promise of a novel antiseptic-barrier cap
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DOI：
10.1086/500280
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发表时间：
2006-01-01
影响因子：
4.5
通讯作者：
Maki, Dennis G.
中科院分区：
文献类型：
--
作者：
Menyhay, Steve Z.;Maki, Dennis G.
背景资料。血管导管的无针阀门连接器在美国各地被广泛使用，因为它们降低了针头和接触人类免疫缺陷病毒和丙型肝炎病毒等血液传播病原体造成的生物危险伤害的风险。长期使用中心静脉导管的患者极有可能感染与导管相关的血流感染，这些感染是由微生物通过给药装置与导管或注射端口之间的连接进入的。大多数医疗从业者在接触之前，先用70%的酒精擦拭无针连接器或注射口的膜间隔。我们报道了一项模拟研究，比较了传统酒精消毒和新型防腐屏障帽的效果，这种新型防腐屏障帽在拧到无针鲁尔激活的阀门连接器上时，允许浸渍了洗必泰的海绵与膜表面连续接触；移除帽后，在接触膜表面之前不需要用酒精消毒。105个商用的无针鲁尔激活的阀门连接器，每个都可以通过钝的公连接器Luerlock附件接触到，从3个制造商那里购买并进行了测试。每个测试设备的膜间隔首先被类似于105个菌落形成单位的粪肠球菌严重污染，然后让其干燥24小时。其中15个被污染的设备没有消毒(阳性对照)，30个用商业70%酒精棉条进行常规消毒，60个将消毒帽拧到连接器上，然后在10分钟后取下。然后用装有营养肉汤介质的无菌注射器进入测试连接器，将其注射到腔内液体通道的下游侧，并进行定量培养。所有15个对照连接器(100%)都显示微生物通过膜间隔大量传播(4,500,000个菌落形成单位)。在用70%酒精常规消毒后进入的30个连接器中，20个(67%)显示微生物传播(442-25,000个菌落形成单位)。相反，在应用新型防腐帽后培养的60个连接器中，只有1个(1.6%)显示出任何微生物传播(P<；.001)结论。这项研究的结果表明，如果无针鲁尔激活的连接器的膜间隔被严重污染，常规的70%酒精消毒不能可靠地防止微生物进入。相比之下，即使在污染非常严重的情况下，防腐屏障盖也提供了高水平的保护。这项新技术值得在临床试验中研究。
Background. Needleless valve connectors for vascular catheters are widely used throughout the United States because they reduce the risk of biohazardous injuries from needlesticks and exposure to bloodborne pathogens, such as human immunodeficiency virus and hepatitis C virus. Patients with long-term central venous catheters are at significant risk of acquiring catheter-related bloodstream infections caused by microbes that gain access through the connection between the administration set and the catheter or an injection port. Most healthcare practitioners wipe the membranous septum of the needleless connector or the injection port with 70% alcohol before accessing it. We report a simulation study of the efficacy of conventional alcohol disinfection before access, compared with that of a novel antiseptic-barrier cap that, when threaded onto a needleless luer-activated valved connector, allows a chlorhexidine-impregnated sponge to come into continuous contact with the membranous surface; after removal of the cap, there is no need to disinfect the surface with alcohol before accessing it.Methods. One hundred five commercial, needleless luer-activated valved connectors, each accessible by a blunt male-connector luerlock attachment, were purchased from 3 manufacturers and were tested. The membranous septum of each test device was first heavily contaminated with similar to 105 colony-forming units of Enterococcus faecalis and then was allowed to dry for 24 hours. Fifteen of the contaminated devices were not disinfected (positive controls), 30 were conventionally disinfected with a commercial 70% alcohol pledget, and 60 had the antiseptic cap threaded onto the connector and then removed after 10 minutes. The test connectors were then accessed with a sterile syringe containing nutrient broth media, which was injected, captured on the downstream side of the intraluminal fluid pathway, and cultured quantitatively.Results. All 15 control connectors (100%) showed massive transmission of microorganisms across the membranous septum (4,50010,000 colony-forming units). Of the 30 connectors accessed after conventional disinfection with 70% alcohol, 20 (67%) showed transmission of microorganisms (442-25,000 colony-forming units). In contrast, of the 60 connectors cultured after application of the novel antiseptic cap, only 1 (1.6%) showed any transmission of microorganisms (P < .001)Conclusions. The findings of this study show that, if the membranous septum of a needleless luer-activated connector is heavily contaminated, conventional disinfection with 70% alcohol does not reliably prevent entry of microorganisms. In contrast, the antisepticbarrier cap provided a high level of protection, even in the presence of very heavy contamination. This novel technology deserves to be studied in a clinical trial.