Disinfection of needleless connectors to reduce Staphylococcus aureus bacterial load
Compare effectiveness of chemical disinfectants in reducing S. aureus.
Five disinfectants reduced the bacterial load, especially chlorhexidine solutions.
Focus on Brazilian clinical practice of needleless connector disinfection
This study aimed to gain further knowledge about the comparative effectiveness of chemical disinfectants in reducing the bacterial load of NCs inoculated with S. aureus.
Disinfection of needleless connectors was undertaken in vitro against S. aureus comparing 70% isopropyl alcohol (IPA), 70% ethanol, 0.5% and 2% chlorhexidine in 70% IPA applied with gauze, and 70% IPA single-use cap (Site-Scrub®).
All disinfectants reduced the bacterial load (P<0.001), especially the chlorhexidine solutions. Mechanical friction should follow guidelines.
This study found that all tested disinfectants effectively reduced the bacterial load and more clinical studies must be developed with a focus on the Brazilian clinical practice of needleless connector disinfection.
Needleless connectors (NCs) provide entry to vascular access devices for the administration of intravenous fluids, medications, blood products, and other intravenous therapies. However, due to connector design, environmental exposure, and manual manipulation, NCs can increase the risk of catheter-associated bloodstream infection (CABSI).1,2 For this reason, clinical practice guidelines such as Infusion Therapy Standards of Practice3 and Guidelines for the Prevention of Intravascular Catheter-Related Infections4 recommend NC external surface disinfection using mechanical friction before each device manipulation. Different chemical disinfectants and NC designs have been introduced to reduce NC bacterial contamination.5 A recent systematic review concluded that alcohol-impregnated single-use caps and alcoholic chlorhexidine gluconate (CHG) wipes were associated with significantly lower CABSI than 70% isopropyl alcohol (IPA) wipes.1 However, this review included no randomized controlled trials or studies evaluating many of the chemical disinfectants used in lower resource settings (eg Brazil). In Brazil, there is a difference in available products for the disinfection of NC in comparison with the USA. In the USA, all disinfectants are available in a single-use option (a wipe or swab), while in Brazil, the disinfectants used can be bulk and applied to gauze for use. There is a lack of studies that replicate techniques used for disinfection in countries such as Brazil.
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