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There are many factors to consider when improving the s […]
There are many factors to consider when improving the safety of patients and healthcare: treatment time, antimicrobials, and ever-increasing reporting standards. However, small devices for needleless connectors for venous systems can have a large impact, especially in protecting health care workers from needle stick injuries and reducing bacterial contamination. These devices have many options and may be confusing with current guidelines and proper disinfection and use procedures. How can health care professionals, such as intensive care nurses and infection prevention specialists, improve patient care and safety and protect themselves with all variables and increasing time constraints? By understanding the differences between device options, healthcare professionals can more easily customize patient care, improve compliance with clinical best practices, and ensure their safety.
Needleless connector features
When determining the disinfection protocol, it is important to consider the function of the needleless connector in use. Common device defects include:
It is difficult to sterilize the gap between the valve and the hub
Complex contact surfaces are more difficult to disinfect
Due to the complexity of the multi-part device, the needleless connector may hide bacteria inside the valve mechanism but outside the fluid path
Medical professionals can use many needleless connector options, and some of these features can affect the difficulty of disinfecting the connector.
Here are some key features to consider when evaluating a needleless connector:
1. External entry surface: Although some needleless connectors appear to have a relatively flat entry surface at first glance, careful inspection reveals different types of surfaces that need to be considered during the sterilization process. See if the surface is flat, sealed and strong. Also, check to see if there are grooves or gaps and if there is a gap around the plunger. These areas are often difficult or impossible to clean adequately, and bacteria in these spaces can cause fluid path contamination. Although the sterilization guidelines vary, a needleless connector has been shown to effectively remove bacteria in as little as 3 seconds, while other needleless connectors may take 15 seconds or more to reduce the risk of bacterial transfer. It is important to look at the specific data for each connector, as the function of each connector accessing the surface can affect effective
2. Internal mechanism and access to the fluid path : Please observe whether the internal mechanism is simple or complicated, because the fluid may accidentally leak or flush into the gap, and the space between the internal mechanism and the connector housing may pinch fluid and contamination. Things. The interstitial space cannot be flushed or sterilized, and contaminants can be transferred from the interstitial space to the luer connector and ultimately to the fluid path. The internal design also has an effect on the flushing, so it is important to adjust the flushing process to ensure proper flushing of the tubing. The amount of fluid required to rinse each needleless connector and catheter may vary, and clinical practice suggests that this range may be between 5ml and 20ml.
3. Visibility: A clear connector allows the healthcare professional to more fully assess whether any residual blood or other infusions, such as blood, total parenteral nutrition or lipid emulsion, remain in the connector. On the other hand, opaque connectors or connectors with multiple components can obscure the fluid path, which adds to the challenge. A clearly visible fluid path facilitates flushing the connector, which clears the catheter and helps keep the catheter open.
4. Blood return: Even if the number of needles is small, the needleless connector will have a negative fluid displacement, which will cause blood to flow back into the catheter when the syringe or IV tube is disconnected. Conversely, if the connector does not produce backflow, such as in the case of a theoretically true neutral displacement connector or a positive displacement connector, no backflow will occur and a particular clamping sequence may not be required. While a positive or truly neutral connector can aid in catheter patency and maintenance of the catheter tip, a key point regarding reflow/displacement is that fluid movement at the catheter tip is independent of microbial intrusion of the connector into the surface.
With these features in mind, a recent survey of professional clinicians found that a smooth outer surface, a gap-free and transparent outer casing seal is the most important feature of a needleless connector.
With multiple options with different key functions, a standardized protocol that requires proper training and assessment of disinfection effectiveness is critical to improving patient care.