Intravenous literature: A recent article by infection control expert William Jarvis, M.D., President, Jason and Jarvis Associates, LLC, highlights the importance of patient safety features in the design of IV needleless connectors.
Healthcare-associated catheter-related bloodstream infections (HA-BSIs) remain a major cause of morbidity and mortality in the U.S. While the Centers for Disease Control and Prevention (CDC) recently reported a drop of 18 percent in the incidence of HA-BSIs, overall progress in reducing these infections has been a fraction of what is possible, and necessary.
The CDC had previously estimated that more than 80,000 HA-BSIs occur annually in intensive care unit (ICU) patients alone. Thus, an 18 percent drop in these infections means that tens of thousands of patients are still endangered by HA-BSIs each year. Many infection control experts believe that HA-BSIs can be markedly reduced, if not completely eliminated. Recognition of the preventability of HA-BSIs is one reason why the Center for Medicare and Medicaid Services (CMS) and many health insurance carriers have eliminated enhanced reimbursement for these complications.
The design of intravenous (IV) needleless connectors (NCs) plays a substantial role in HA-BSI risk. These devices are used to connect catheters, administration sets, and/or syringes to deliver IV therapy. In the past two decades, connectors have evolved in a direction that has inadvertently increased the risk for HA-BSIs.
With some notable exceptions, the devices have become more complex in design. These complexities have made NCs harder to: disinfect, flush completely, and use correctly. This situation is compounded by the wide variety of NCs in the marketplace. Clinicians often are faced with several types of NCs in use at their hospital or healthcare system. Because each NC can require different routines for proper use (i.e., disconnection, clamping, disinfection and flushing sequence) such variety can be confusing to clinicians and endanger patientsâ€™ lives. The confusion can lead to medical errors, and ultimately HA-BSIs.
This article provides a short history of IV needleless connectors, to show how the current situation developed, and then describes the crucial features of NCs that reduce the risk of HA-BSIs.