Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte)

Abstract

BackgroundMany cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as “intervention”), we compared luer lock caps with a “closed access system” consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety).MethodsFor determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination.ResultsWith the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-value<0.05) confirmed the significance of the result.In 50 reviewed samples (TWC’s), the contamination rate for the luer lock cap was 8% (4 out of 50 samples were positive), the contamination rate of the 50 samples with the closed access system was 0%.Possible hygienic risks (related to material, surroundings, staff handling) could be reduced by 65.38%.ConclusionsIn the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene.

Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line–associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC)

“…25 The results for average process costs were statistically significantly lower with the use of SS devices (V2.55 vs V3.92). 25 Regarding the microorganisms profile, the predominant microorganisms identified Enterococcus spp (25%) in the SS þ SUF group and Klebsiella spp (20%) in the 3WSC group.…”

“…25 The results for average process costs were statistically significantly lower with the use of SS devices (V2.55 vs V3.92). 25 Regarding the microorganisms profile, the predominant microorganisms identified Enterococcus spp (25%) in the SS þ SUF group and Klebsiella spp (20%) in the 3WSC group. In a study by Salgado et al, a significantly higher percentage of CLABSIs caused by gramnegative organisms was found during the needleless MV device period compared with the SS device period (39.5% vs 8%; P ¼ .007).…”

“…The contamination rate was 8% for the 3WSC (4 out of 50 samples positive), compared with 0% for SS (0 out of 50 samples). 25 This is the first RCT to examine the effect of using SS þ SUF vs 3WSC on the incidence rate of CLABSI and to assess the costeffectiveness of the 2 types of devices, which is sufficient ethical and theoretical justification for conducting this particular trial and, through its publication, increasing and spreading awareness on this public health burden in Indiaethe second largest country of the world, with a population of approximately 1,300,000,000 people, 26 as well as throughout the developing world where 3WSCs are in use. 2,27 …”

“…Several previous quasi-experimental studies have evaluated the impact after switching from SS to MV needleless connectors, which resulted in increased rates of CLABSI. 16,18,23,24 Only 1 recent study, by Pohl et al, 25 compared labor and material costs per use and contamination rates in SS and 3WSC. The results for average process costs were statistically significantly lower for the closed access system (SS) than for the luer lock caps (3WSC) (V2.55 vs V3.92).…”

Kinderonkologie: Erhaltungspflege von Broviac- und Port-Kathetern

“…15000-mal pro Jahr. Hierbei besteht ein nicht zu vernachlässigendes Kontaminationsrisiko [92], das sich möglicherweise durch den Einsatz vorkonfektionierter Spritzen verringern lässt, die sterile Kochsalzlösung (NaCl 0,9 %) enthalten [16,72]. Leider haben die kommerziell erhältlichen Spülspritzen den Nachteil unangenehmer Geschmacksensationen bei einigen Patienten, sodass die Kinder lernen, zwischen "gutem und bösem Kochsalz" zu unterscheiden.…”