When determining a disinfection plan, it is important to consider the function of the needleless connector in use. Common equipment defects include:
It is difficult to disinfect the gap between the valve and the hub
Complex contact surfaces are more difficult to disinfect
Due to the complexity of multi-part equipment, needleless connectors may hide bacteria inside the valve mechanism but outside the fluid path
Medical professionals can use many needleless connector options, and some of the above characteristics will affect the difficulty of connector sterilization.
Here are some key features to consider when evaluating pinless connectors:
1. External access surface: Although some needleless connectors may seem to have a relatively flat access surface at first glance, a closer inspection can reveal different types of surfaces that need to be considered during the disinfection process. See if the surface is flat, sealed and strong. In addition, check to see if there are grooves or gaps and if there are gaps around the plunger. These areas are often difficult or impossible to clean adequately, and bacteria in these spaces can cause contamination of the fluid path. Although the sterilization guidelines vary, one needleless connector has been proven to effectively remove bacteria in as little as 3 seconds, while other needleless connectors may require 15 seconds or more to reduce the risk of bacterial transfer. It is important to review the specific data of each connector, because the function of each connector to access the surface may affect the effective disinfection.
- Internal mechanism and channel to the fluid path: Observe whether the internal mechanism is simple or complex, because the fluid may accidentally leak or flush into the gap, so the space between the internal mechanism and the connector housing may trap fluid and contaminants . The interstitial space cannot be rinsed or sterilized, and contaminants can be transferred from the interstitial space to the Luer connector and ultimately to the fluid path. Internal design also has an impact on flushing, so it is important to adjust the flushing process to ensure proper flushing of the pipeline. The amount of fluid required to flush each needleless connector and catheter may vary, and clinical practice indicates that the range may be between 5ml-20ml.
- Visibility: The clear connector enables healthcare professionals to more fully assess whether any residual blood or other infusions remain in the connector, such as blood, total parenteral nutrition, or lipid emulsion. On the other hand, opaque connectors or connectors with multiple components can obscure the fluid path, which can increase the challenge. The clearly visible fluid path will prompt the connector to flush properly, which will clear the catheter and help keep the catheter open.
- Blood reflux: Even if the number of needles is small, a needleless connector that will exhibit negative fluid displacement will cause blood to return to the catheter when the syringe or intravenous infusion tube is disconnected. Conversely, if the connector does not produce reflow, such as in the case of a true neutral displacement connector or a positive displacement connector in theory, reflow does not occur, so a specific clamping sequence may not be required. Although a positive or truly neutral connector can help catheter patency and maintenance of the catheter tip, the key point about return/displacement is that the fluid movement of the catheter tip is not related to microbial invasion of the connector entry surface.
Taking into account these characteristics, a recent survey of professional clinicians found that a smooth outer surface, no gap at the septum seal, and a transparent housing are the most important characteristics of a needleless connector.
With multiple choices with different key functions, the need for proper training and standardized protocols to evaluate the effectiveness of disinfection are essential to improve patient care.
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