1. Research is Prevention HAIs and Needleless Connectors
Enter Name and position as appropriate
Note: This presentation is intended to be a discussion of the presentation and publication activity over the last several years on the topic of needleless connectors and the impact they MAY be having on BSI occurrence.
Deb Richardson, RN, MS, CNS

3. SHEA/IDSA Practice Recommendation October 2008
Compendium of Strategies to Prevent HAIs in Acute Care Hospitals
Contains four device- and procedure-associated HAI practice recommendations
Prevention of CLABSI
Prevention of VAP
Prevention of CAUTI
Prevention of SSI
Contains 2 organism-specific HAI categories
MRSA transmission
CDI
Announced - October 8, 2008
Available for free download on the SHEA and IDSA websites
Supported by:
Joint Commission
American Hospital Assoc.
HICPAC (Healthcare Infection Control Practices Advisory Committee)
APIC

4. Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals
Catheter Insertion Recommendations
- Catheter insertion checklist
Hand Hygiene
Avoid femoral vein in adults
All inclusive catheter cart/kit
Maximal sterile barrier
CHG for skin preparation
Post-Insertion Recommendations
Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter with CHG/Alcohol or 70% alcohol
Remove non-essential catheters
Dressing changes with CHG-based antiseptic

5. Practice Recommendation Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals
Approaches that should NOT be considered a routine part of CLABSI prevention
NO antimicrobial prophylaxis for catheter insertion or dwell
NO routine replacement of CVCs or arterial catheters
Do not routinely use positive-pressure needleless connectors with mechanical valves before a thorough assessment of risks, benefits, and education regarding proper use
Routine use of the currently marketed devices that are associated with an increased risk of CLABSI is not recommended.
**This recommendation is supported by the three studies, Rupp, Salgado, and Field
Point out that this recommendation comes with the same level of recommendation as the following:
Perform hand hygiene before catheter insertion or manipulation
Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter
Use a catheter checklist to ensure adherence to infection prevention practices at the time of CVC insertion.
Use an all-inclusive catheter cart or kit
Perform surveillance for CLABSI
Be prepared to describe the recommendation criteria from the article

6. Topics for Discussion Factual Information Technology Review
HAI Rates
Reimbursement Impact
Regulatory Issues
Mandatory Reporting
Technology Review
Evolution
Current Products
Research/Publication Update
Questions
Review topics for discussion

7. Presentation Objectives
Participants will be able to:
Discuss the current rates and financial impact of CR-BSI on the US Healthcare system
Review current needleless technologies available today
Describe recent research/publication activities regarding needleless access device use
Read the slide
Note to presenter:
These are the objectives to be met. These are most important if the facility is planning to provide nursing continuing education credits for the presentation. They will need to provide the participants an evaluation form with these objectives listed.

8. The Facts Healthcare Acquired Infections (HAIs)
1.7 Million patients diagnosed with HAIs each year
33,269 Newborns in High Risk Nurseries
19,059 Newborns in Well Baby Nurseries
417,946 Adults and Children in ICUs
1,266,851 Adults and Children Outside the ICU
Review current state around HAI’s in the US – Read the stats
This is the most current info available
Klevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.

9. The Facts 98,987 estimated deaths annually associated with HAIs
35,967 Pneumonia
30,665 BSIs
13,088 UTIs
8,025 SSIs
11,062 Other sites
Review current state around HAI’s in the US – Read the stats
Klevens, R. Monina. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, Public Health Reports. Vol. 122, March-April 2007.

10. Healthcare Associated Infections
Deaths/yr.
Of key interest here is that more patients are dying from HAI’s than other major diseases. Take 90K and divide by # of days = over 240 deaths per day!!!!
ALOS (Average Length of Stay) Extended length of stay has a major impact on the expenditures
Resistant organisms are of major concern, because antibiotics to treat these infections are often extremely limited.
90,000 deaths/yr  over 240 per day2
Average length of stay 21.1 days vs. 4.5 days1 (with/without HAI)
70% due to organisms resistant to at least one key antibiotic (i.e., MRSA, VRE)2
1 PHC4 Research Brief. Hospital-acquired Infections in Pennsylvania. Issue No. 9. March 2006
2 Campaign to prevent antimicrobial resistance in healthcare settings. ww.cdc.gov/drugresistance/healthcare/problem.htm

11. The Facts HAIs Cost More Than $4.5 billion annually
JCAHO and NQF are focused on prevention efforts
HAI prevention is a top focus for professional organizations such as: SHEA and APIC
AND
As of October 2008 Medicare no longer pays for certain preventable conditions
CRBSIs included in this list
Reder A. Public Reporting of HAIs: Where do we stand now? Infection Control Today. August 2007.

12. Attributed Financial Burden is High
Study of 232,651 admissions from 13 hospitals
63%
Reduction
in profits No
HAIs
With
HAIs
The 5% of patients acquiring
infection eroded $56MM in profits
This study demonstrates the impact HAIs have on hospital revenues.
Of note, only a small number of patients developing an HAI can have major impact on the revenue picture
% Patients
# Patients
95%
221,225 5%
11,426
100%
232,651
Reference: MedMined, June 2005

13. The Facts Regulatory Impact JCAHO CDC
2009 National Patient Safety Goals
Reduce the risk of HAIs
Manage as sentinel events all identified cases of death or major loss of function associated with a HAI
Implement best practices or evidence-based guidelines to prevent CLABSI
CDC
National Healthcare Safety Network (NHSN)
Previously National Nosocomial Infection Surveillance (NNIS)
Available to all hospitals
Data available to all healthcare facilities and the general public
JCAHO– 2 of the Patient Safety Goals speak to HAIs
The CDC has announced the implementation of a web-based reporting network that lets facilities track infections. They currently have over 600 participants from 45 States.

14. Public Awareness Headlines Government and Consumer Groups
AARP Bulletin (March 2009)
“Killer Germs”; Superbugs Kill 90,000 patients a year.
Government and Consumer Groups
Consumers Union
Go to: State Hospital Infection Disclosure Laws”
Leapfrog Group
Provides ratings of 1,300 US Hospitals
Centers for Medicare and Medicaid Services (CMS)
Reports quality information on hospitals
Committee to Reduce Infection Deaths
Victoria Nahum, patient advocate
A great deal of media attention. Public much more aware.
Safecarecampaign.org is a website that offers information and references to HAI preventative strategies. Victoria Nahum lost a 24 year old son to an HAI. She has become a spokes person for prevention efforts.

15. Mandatory Reporting Mandatory Reporting of Infections
States that have passed legislation
States with study bills
NC, IN, AZ, OH, NM, and AK

16. Mandatory Reporting of HAIs
Map of the previous slide
Interactive opportunity:
Depending on the state the presentation is being presented, we discuss activity in that area.

17. Pennsylvania Pennsylvania Health Care Cost Containment Council (PHC4)
1st State with Public Reporting Data, 2004
This is a sample of Pennsylvania’s output from this type of legislation.
11,668 HAIs, $613.7 Million (estimate total additional payment)
PHC4 Research Brief. Hospital-acquired Infections in Pennsylvania. Issue No. 9. March 2006

18. Mandatory Reporting Issues
No Standardization
Some states publish info/some don’t
Some measure processes/some HAIs
Some use administrative data
Some report organisms (e.g., MRSA)
Will we see mandatory reporting move from a State to a Federal level?
Some of the discussion around mandatory reporting is the inconsistency in the effort. Very similar to Needlestick safety. Until there was a federal law, there was variables in practice changes.
Review bullet points. Ask the audience for participation here:
Do they have opinions on this topic?

19. Bloodstream Infections Facts
87% of primary bacteremia attributed to vascular access
Crude mortality 10% - 40%
Prolonged hospitalization days
Attributable cost $34,000 - $56,000 per stay
80,000 CRBSIs occur in ICUs each year
million occur outside ICU
Annual cost to the healthcare system is $296 million - $2.3 billion (US)
HAI’s consist of primarily:
Ventilator Associated Pneumonia
Urinary Tract Infections
Surgical Site Infections
Bloodstream Infections
This slide breaks out CRBSI from the bigger picture. Review the numbers and bullet points.
Note: Most of this data comes from reports out of ICUs and relate to CVLs only.
William R. Jarvis, M.D., “Preventing Central Venous Catheter (CVC)-Associated Bloodstream Infections in 2005: Is Zero Realistic?” Oral presentation at the Infusion Nurses Society Annual Meeting (May 2005, Ft. Lauderdale, FL).
Mermel LA. New Technologies to prevent intravascular catheter-related bloodstream infections. Emerging Infectious Diseases. 2001;7:

20. How Infections Are Transmitted
Means of Transmission
Reservoir
Susceptible Host
Causative Agent
Review how infections occur.
All the puzzle pieces must be present in order for transmission to occur. Take away one piece and the infection will not happen.
Causative agent = the microorganism, or germ, that can cause illness or disease.
Means of transmission = the mechanism for transfer of infectious agent from reservoir to susceptible host.
Reservoir = [or carrier] place in which the infectious agent can survive. [rats are reservoirs for plague; mosquitoes are reservoirs for malaria]
Portals of entry & exit = the paths by which the infectious agent leaves the reservoir and enters the susceptible host.
Susceptible host = in this case, the patient-
Portals of Exit & Entry 20

21. Susceptible Host Risk Factors Acuity of illness
Less than 1 year of age or over 60
Immunocompromised
Underlying disease processes
Loss of skin integrity
Prolonged hospitalization
Existing infections
Malnutrition
In ICU
Type of catheter
Frequency of manipulation of the catheter
Discuss risk factors that are often out of the control of the clinician.

22. Portals of Entry Inadequate hand washing Insertion experience
Disinfection of skin site
Contaminated infusate
Field or ER insertion
Multiple entries into the system (hubs, injection ports, stopcocks)
This slide demonstrates all the “portals of entry” . Note that multiple entries increase risk. 22

23. CRBSI Reduction Strategies
Procedure
Procedure
Process
CVC Insertion Cart
Insertion Checklist/Bundle
Review this graphic to describe the factors that may impact risk of BSI.
Much of the focus has been on process and compliance to procedures. However, another major factor contributing to the rise in CRBSIs may be product design.
Examples of these:
Procedure
CVC Bundle
CVC Kits
Process
Education/hand washing
Tubing Changes
Surveillance
Product Design
Coated CVCs– some review indicates positive impact
?? Needleless Access
Process
Product
Staff Awareness
Measuring Compliance
Coated CVCs/NCs
CHG dressings/discs

24. Product Evaluation Needleless Access Devices
Procedure
Process
Procedure
You can even take the graphic down another level, to the product itself:
Procedure
Change Frequency
Process
Aseptic Technique
Clean before each access
Product Design
Needleless Access has evolved from very Simple to Complex
Can design have an impact???
Change Frequency
Blood draw via cap
Process
Design
Smooth Surface
Any gaps or crevices
Clear vs. Opaque
Complex Fluid Path
Aseptic Technique
Cleaning cap prior to each access
Flushing effectiveness

25. Needleless Access Devices
Technology Review
Transition slide to discuss technology

26. This chart is used to review the evolution of needleless technology.
Some audiences may need more explanation than others about these different technologies. Explain that all of these IV sites are available in both primary and secondary positions in the IV set up.
Review the generations in relation to simple vs complex

27. This poster demonstrates the Simple, Complex and More Complex evolution.
Another discussion point is that all the devices look similar and that confusion exists in the clinical setting as to the requirement around clamping.

28. Simple vs. Complex Simple Complex More Complex Split Septum Mechanical
Valve
More Complex
Positive
Fluid Displacement
Use this graphic to demonstrate the Simple, Complex, More Complex that evolved in the designs.
Discuss that in the more simple technology, the cannula is the fluid path, which is removed following administration.
In the complex devices, there is some part that moves to open the fluid path, leaving a space where fluid particles could adhere.
In the More complex, there is an actual “reservoir” that fills and then is expelled during disconnection. This space/reservoir is at risk of being coated with TPN or blood products. 28

29. RESEARCH & PUBLICATION HISTORY

31. Publication History
2004
University of Virginia observed a 61% increase in BSI rates after switching from split septum technology to a mechanical valve
Made the switch due to pump supplier change
2005
Wake Forest observed an increase in BSI’s after switching from split septum technology to mechanical valve
Repeated in-service of nursing staff on proper device use did not lower BSI rates
Dr. William Jarvis formed first study group to study BSI outbreak
5 hospitals reported increases in BSI rates after switching from split septum technology to a mechanical valves
2006
Wake Forest reports gross bacterial contamination of two mechanical valves after removal from patients
In 2004 UVA presented this poster at the annual SHEA meeting. From our knowledge most of the information presented around this topic in the past has been related “open vs closed” systems. This is the first info that we are aware of that identified a difference in needleless access device designs.
This initial presentation prompted Dr. Jarvis (previously with the CDC) to gather info from other IC professionals who had experienced increases in BSI rates when moving from the Interlink system to a variety of the newer more complex mechanical valves. That data has been presented an various venues around the country over the last several years and has generated interest and research into this topic around the world.
Wake Forest University even went to the extent of cutting the devices open and evaluating contamination rates.

32. Tobi Karchmer, et al, SHEA 2006 Poster
Contamination of Mechanical Valve Needleless Devices May Contribute to Catheter-related Bloodstream Infections
Tobi Karchmer, et al, SHEA 2006 Poster
Devices: “MVDs from 2 different manufacturers (Device A and B) and a spilt septum device (SSD) (device C) were examined over four time periods: Phase I: Device A; Phase II: Device A after ICU nursing staff education on disinfection; Phase III: Device B; Phase IV: Device C. Utilization of Device B and C was after ICU nursing staff education on use and disinfection of each device.”
Key Results: “There was no difference in the proportion of contaminated devices between the 3 that were evaluated after education, although Device A and B had significantly more colony-forming units cultured.”
Device A (MVD): 83% TNTC*
Device B (MVD): 60% TNTC
Device C (SSD): 0% TNTC*
*TNTC = "Too numerous to count"... categorized as "Highly Contaminated Devices“
Conclusions: “CRBSI significantly increased in this tertiary care hospital upon the introduction of an MVD and only modestly improved following nursing staff education on device utilization. Bacterial contamination of blood drawn from all three needleless devices was common, and although it is less following improved device use, it is still considerable. Device C (SSD) appeared to have lower internal contamination. Further studies on the impact of SSD on overall CRBSI need to be preformed.”
Discuss Karchmer presentation
Q-syte is Device C
Read the conclusion

33. Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
Dr. William Jarvis presented his thoughts around potential risk factors for BSI’s associated with mechanical valves as follows:
Factor
Difficulty cleaning access surface
Potential Impact
HCWs may not adequately clean the intricate surface details before access, leading to fluid path contamination.
Gap around plunger harbors bacteria
Gap cannot be accessed for disinfection and can lead to fluid path contamination
Opaque housing hides incomplete flushing of media based fluids
During normal manipulation, small amounts of bacteria and media-like fluids contaminate the valve. If these organisms proliferate, then they can be infused with subsequent manipulations.
Dr. Jarvis’ presentation refers to 4 distinct risk factors that may influence the findings:
List all of these, next slides show examples of the characteristics of different devices. Important to note that ALL of these may have an influence.
Internal mechanisms obscure fluid path
Impossible to visually confirm complete flushing.
W. Jarvis, M.D., “Increased Central Venous Catheter-Associated Bloodstream Infection Rates Temporally Associated With Changing From A Split Septum To A Leur Access Mechanical Valve Needleless Device: A Nation-wide Outbreak? CHCA Meeting, Chicago, IL Sept. 24, 2005.

34. Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Difficulty cleaning access surface”
Rough vs smooth surface area
Rough surface, harder to clean and may harbor bacteria

35. Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Gap around plunger harbors bacteria”
Gap around plunger vs tight seal
Gap may allow bacteria to migrate into the device

36. Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Opaque housing hides incomplete flushing of media based fluids”
Opaque vs clear
Difficult to tell if the flushing has been adequate. Point out that INS standards of practice state to flush until clear or the device should be removed.
2006 INS Standards of Practice state: “If the integrity of the injection or access cap is compromised or if residual blood remains within the cap, it should be replaced immediately…” (S36)

37. Potential Risk Factors for Bloodstream Infections Associated with Mechanical Valves
“Internal mechanisms obscure fluid path”
Internal mechanisms: simple vs. complex
Reinforce the issue that in the simple split septum design, the cannula is the “fluid chamber/path”, where in other more complex devices, the fluid chamber/path remains after disengagement. 37

38. Baxter Interlink® Smooth Surface No Gap Clear Simple Internal Design
High Flow Rates
Accepts Needle in Emergency
BD Bifurcated Cannula Improves Flushability
Small & Light Weight
Latex-free
So how do BD Q-Syte and Baxter Interlink products match up to the Jarvis List:
Good time to show barrel demo
Q-Syte and Interlink meet ALL four strengths
Review other attributes 38

39. BD Q-Syte™ Luer Access Split Septum
Smooth Surface
No Gap
Clear
Simple Internal Design
Accepts both Luer Lock and Luer Slip Connections
High Flow Rates
Small & Light Weight
Latex-free
So how do BD Q-Syte and BD Interlink products match up to the Jarvis List:
Good time to show barrel demo
Q-Syte and Interlink meet ALL four strengths
Review other attributes 39

40. 2007 Publications
2007
Geelong Hospital, Victoria, Australia reports a 2.2 fold increase in BSI’s after switching from split septum to mechanical valve
Infection Control and Hospital Epidemiology
The University of Nebraska Medical Center reports a 3.3 fold Increase in BSI’s after switching from split septum to mechanical valve
Clinical Infectious Diseases
Medical University of South Carolina reports a 2.7 fold increase in BSI’s after switching from split septum to mechanical valve
All three facilities returned to split septum and their BSI rates returned to original levels
In the summer of 2007, 3 publications highlighted this same experience.

41. Research Summary Recent Publications Summary:
Incidence of Catheter-Related Bloodstream Infection Among Patients with a Needleless, Mechanical Valve-Based Intravenous Connector in an Australian Hematology-Oncology Unit
Kathryn Field, MBBS et al. Infection Control and Hospital Epidemiology, May 2007, Vol. 28, No 5.
Summary:
400-bed regional public hospital/Victoria Australia
SS/Baxter Interlink® vs MV/Abbott Clave® and CLC 2000
Study period July 2004 through June 2005
98 patients with Hickman Catheters (SL and DL)
Hem/Onc Unit
2.6 infections vs 5.8 infections per 1000 catheter-days
Split Septum === Baxter Interlink
Vs Mechanical Valve (Clave and CLC 2000)
Study period July 2004 through June 2005
98 patients with Hickman Tunneled Catheters
32 confirmed BSI in 25 patients
20 in the MV period and 12 in SS period
62 patients in MV period = 3468 catheter days
83 patients in SS period = 4539 catheter days
Median Time to 1st BSI in MV period = 44 days
Median Time to 1st BSI in SS period = 65 days
(p value .17 by log rank test)
The authors breakout the results by tumor types:
Leukemia; solid organ; other hemotologic conditions
Looked at DL vs SL

42. Research Summary Recent Publications
Outbreak of Bloodstream Infection Temporally Associated with the Use of an Intravascular Needleless Valve
Mark E. Rupp, et al. Clinical Infectious Diseases, June 2007, Vol. 44
Summary:
SS/Interlink vs PDMV/Alaris Smartsite Plus vs SS/Interlink
Increase in CRBSI rates with the introduction of a positive displacement connector valve and decrease after return to SS
CC = 3.87/1000 vs 10.64/1000 (p<.001)
Six month period following return to SS 5.59/1000 (p = .02)
Inpatient = 3.47/1000 vs 7.3/1000 (p=.02)
Six month period following return to SS 2.88/1000 (p = .57)
Similar results seen in 2 cooperative care transplantation units
Split –Septum vs Mechanical Valve
Interlink vs Alaris Smartsite
Critical Care Areas: 8 critical care units and transplantation units
Total 38,250 CVC days over 26 months (Baseline) with SS
10,340 CVC days over 6 months (PDMV period)
SS 3.87/1000 to PDMV 10.64/1000 p value < .001
In the six months following discontinued use of PDMV the rate returned to 5.59/1000 with a p value of .02 compared to baseline (3.87/1000).
9 inpatient units:
#2 one month observation periods
3745 CVC days
SS 3.47/1000 baseline
PDMV 7.3/1000
2.88/1000 during post intervention period 11, 475 CVC days
No significant difference from baseline
2 Cooperative Transplant Units:
Baseline 5.31/1000 patient days
Total Patient Days: 7535 over 26 months
1383 patient days over 6 months (PDMV period)
SS 5.31/1000 to PMVD 15.18/1000 patient days p value<,001
6 months following rate returned to baseline

43. Research Summary Recent Publications
Increased Rate of Catheter-Related Bloodstream Infection Associated with Use of a Needleless Mechanical Valve Device at a Long-Term Acute Care Hospital
Cassandra D. Salgado, et al. Infection Control and Hospital Epidemiology, June 2007, Vol. 28, No. 6
Summary:
59 bed long-term care facility
SS/Interlink vs Alaris Smartsite vs SS/Interlink
Three-fold increase in BSI rates
Location: 59 bed long-term acute care hospital, Sth Carolina switched from NSSD to Smartsite in Q1 2004
Study Design:
Comparison of rate and microbiology of CR-BSI before and after MV use (2 year’s CR-BSI data)
Results:
CR-BSIs increased significantly from 1.79 to 5.95 per 1000 catheter days (RR 3.32, 95%CI p<.001) during the time the MV system
65% relative increase in BSIs that were polymicrobial
Contributed to 46 excess BSIs of which likely there were 5-12 excess deaths and additional cost of between $USD million
In the 6/12 following return to SS CR-BSI rate reduced to 1.70 per 1000 catheter days (95% CI, p<.001)
Conclusion:
Sustained, significantly increased CRBSI rate associated with MV use despite repeated education regarding proper use.
Decrease in rates associated with return to SS technology
Formal assessment of MVs in warranted as likely that the current design/ and or protocols for disinfection may not be safe or adequate for patient use
Facilities using MVs need active surveillance systems in place.

44. Research Summary
Study to evaluate effectiveness of closed, luer SS device in reducing CRBSI
Adult Medical ICU
Previously used PPMV
CRBSI rate (PPMV): per 1,000 catheter days
CRBSI rate (CLSS): 0 at 3, 6, 8 months after implementation
Identified significant reduction in infection rates for adult medical-ICU population
Love, K. Catheter-related bloodstream infection rates decrease to zero in the ICU after implementing a closed luer access split-septum device. Poster Presentation, AVA 22nd Annual Conference, Savannah, GA. 2008

45. Research Summary 410 bed acute care facility in SE
Study performed in MSICU ( )
Utilized PPMV
CRBSI rate (PPMV): 7.9 per 1,000 catheter days
Evaluated CLSS device
CRBSI rate (CLSS): 4.4 per 1,000 catheter days & eventually achieved a rate of 2.36
Kirley, D., et al. Impact of changing from a luer access mechanical valve to a luer access split septum device on the reduction of central line-associated bloodstream infections in a medical surgical intensive care unit. Poster Presentation; AVA 22nd Annual Conference, Savannah, GA. 2008

46. Portal of Entry and a Reservoir?
Recent data suggests that the needleless connector could not only be a portal of entry, but also a “reservoir”
Portals of Exit & Entry
Reservoir
The question now is… can the needleless device be the reservoir where the bacteria are seeding and multiplying. Then a flush or drug administration causes release of high numbers into the patient bloodstream, increasing the risk of BSI. 46

47. Microbial Colonization of Needleless Connectors
In vitro study to evaluate presence/distribution of bacteria on external surfaces/internal fluid path of NCs after clinical use
MICU patients
All had silicone ss & internal collapsible silicone mechanical valve
Results: prevalent microorganisms (multiple species) on external surface in biofilms; internal path revealed mixed species of microorganisms
Biofilm observed covering all areas of surface in various stages of development
“Transfer of microorganisms as single cells or biofilm fragments through the connector allows for biofilm colonization on the internal lumen of the catheter and potential bacteremia”
Ryder, M. et al. Microscopic examination of microbial colonization of needleless connectors. Poster Abstract 5-36, APIC 35th Annual Education Conference & International Meeting, June 15-19, 2008, Denver, CO.

48. CRBSI & NCs Based on the information available today……..
Patients are 3 times more likely, on average, to develop a CRBSI with the use of a mechanical valves versus a split septum needleless system.1,2
Did you know that patients are 3 times more likely to develop a CRBSI with a more complex mechanical valve system than with your current Interlink system!
Cassandra D. Salgado, et al. Infection Control and Hospital Epidemiology, June 2007, Vol. 28, No. 6.
Mark E. Rupp, MD. Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve. CID 2007; 44 (1 June):

49. M. D. Anderson Cancer Center Experience
2003- closed luer split-septum/prior-SSBC
Avoided MV’s due to concerns related to contamination and increased risk of infection
Benefits of CLSS:
Easy to use/clean
Clear housing
Simple device
Straight/free flowing fluid path
No internal mechanism to harbor bacteria

50. Infection Prevention Measures
Hand washing!!
Wear gloves/PPE
Skin prep prior to access and maintenance
Clean access sites prior to each entry
Frequent observation of site
Evaluate continued need for access
Incorporate central line bundle/line cart/kits
Evaluate ALL changes in the infusion system independently for any change in BSI outcomes!
Hand hygiene = 1ST LINE OF DEFENSE. Soaps, disinfectants, alcohol-based gels/lotions
Gloves = could be either sterile or un-sterile; depends on policy and procedure; patient condition, etc
Skin preps – CDC prefers CHG but 70% alcohol, 10% iodophors, tincture [alcohol] of iodine are all OK too.
Persist = iodophor/alcohol/protective barrier
Dressing changes: choose the best prep, use friction, use clean to dirty in circular motion using friction or back and forth motion [as in ChloraPrep label]
Site – look for S/S of inflammation, redness, pain, purulent drainage
Evaluation – Need to continue using vs. need to remove due to a possible complication
IV start paks and custom dressing change kits keep required supplies in one place.
>Increases ability for staff to follow hospital protocols and procedures
>Decreases waste
>Saves nursing time

51. Summary Be Informed about the product
Be aware of changes in products that may have an impact on your outcomes
Communicate with others in your institution who may be involved in the introduction of new technology
Utilize available resources/information to assist in making informed decisions & improving patient outcomes
Summarize discussion
Encourage looking at outcomes not just clinician preference.
Emphasize the quote from Trish Perl at Johns Hopkins