Major Articles
Prevention of catheter-related bloodstream infection in critically ill patients using a disinfectable, needle-free connector: A randomized controlled trial

https://doi.org/10.1016/j.ajic.2003.12.004Get rights and content

Abstract

Objective

The aim of this study was to assess the efficacy of a disinfectable, needle-free connector in the prophylaxis of catheter-related bloodstream infection.

Methods

A randomized controlled trial was performed in a polyvalent intensive care unit. Patients who needed multilumen central venous catheters were randomly assigned to a study or a control group. All catheters were inserted and manipulated according to the Centers for Disease Control and Prevention (CDC) recommendations. Study group patients were equipped with catheters with disinfectable, needle-free connectors whereas control group patients were equipped with catheters with 3-way stopcocks. Two peripheral blood cultures and a semiquantitative culture of the catheter tip were performed on removal of the catheter.

Results

The study included 243 patients, with a total of 278 central venous catheters. The catheters' mean insertion duration was 9.9 days. Both groups were comparable regarding patient and catheter characteristics. Incidence rate of catheter-related bloodstream infection was 0.7 per 1000 days of catheter use in the study group, compared with 5.0 per 1000 days of catheter use in the control group (P = .03).

Conclusions

To add a disinfectable, needle-free connector to the CDC recommendations reduces the incidence of catheter-related bloodstream infection in critically ill patients with central venous catheters.

Section snippets

Material and methods

A randomized controlled trial was designed in a 12-bed polyvalent ICU in a 420-bed university hospital. Critically ill patients who fulfilled all selection criteria were consecutively recruited and randomly assigned to one of two study groups on the insertion of the first central venous catheter (CVC). Inclusion criteria were the need for a subclavian or jugular nontunneled, noncoated, polyurethane central venous multilumen catheter. CVCs inserted outside the ICU, removed before 72 hours of

Results

A total of 243 patients met the selection criteria and were randomized to one of the 2 treatment arms. In all, 278 catheters were inserted, with a maximum of 7 catheters per patient and with a mean duration of insertion of 9.9 days. From the 278 catheters studied, 91 (32.7%) corresponded to medical patients, 101 (36.3%) to surgical patients, and 86 (31.0%) to trauma patients. The mean of the severity of patients' illnesses on admission according to SAPS II was 34.0 (SD 12.1), and the mean of

Discussion

This study shows a reduction in the number of CRBI cases in the group that used a disinfectable, needle-free connector. It included only a selected population of multilumen central venous catheters inserted in critically ill patients for more than 72 hours. This type of catheter is particularly susceptible to bacterial colonization through handling because it is used for different purposes at the same time, such as central venous pressure monitoring, blood sampling, administration of TPN,

Acknowledgements

The authors thank the nurses at the Intensive Care Unit of the “Dr Josep Trueta” University Hospital of Girona.

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    Desinfectable needle-free connectors were provided by Alaris Medical Systems (San Diego, Calif) without charge.

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