caa a22 4500 388033231 CHVBK 20180307124957.0 cr unu---uuuuu 161130e199806 xx s 000 0 eng 10.1086/647839 doi S0195941700087828 pii (NATIONALLICENCE)cambridge-10.1086/647839 Study of a Needleless Intermittent Intravenous-Access System for Peripheral Infusions: Analysis of Staff, Patient, and Institutional Outcomes [Elektronische Daten] Abstract OBJECTIVE: To assess the effect on staff- and patient-related complications of a needleless intermittent intravenous access system with a reflux valve for peripheral infusions. DESIGN: A 6-month cross-over clinical trial (phase I, 13 weeks; phase II, 12 weeks) of a needleless intermittent intravenous access system (NL; study device) compared to a conventional heparin-lock system (CHL, control device) was performed during 1991 on 16 medical and surgical units. A random selection of patients was assessed for local intravenous-site complications; all patients were assessed for the development of nosocomial bacteremia and device-related complications. Staff were assessed for percutaneous injuries and participated in completion of product evaluations. A cost analysis of the study compared to the control device was performed. SETTING: A 1,100-bed, teaching, referral medical center. PATIENTS AND STAFF PARTICIPANTS: 594 patients during 602 patient admissions, comprising a random sample of all patients with a study or control device inserted within a previous 24-hour period on study and control units, were assessed for local complications. The 16 units included adult inpatient general medicine, surgical, and subspecialty units. Pediatrics, obstetrics-gynecology, and intensive-care units were excluded. All patients on study and control units were assessed for development of nosocomial bacteremia and device-related complications. All staff who utilized, manipulated, or may have been exposed to sharps on study and control units were assessed for percutaneous injuries. Nursing staff completed product evaluations. INTERVENTION: The study device, a needleless intermittent intravenous access system with a reflux valve, was compared to the control device, a conventional heparin lock, for peripheral infusions. RESULTS: During the study, 35 percutaneous injuries were reported. Eight injuries were CHL-related; no NL-related injuries were reported (P=.007). An evaluation of 602 patient admissions, 1,134 intermittent access devices, and 2,268 observed indwelling device days demonstrated more pain at the insertion site for CHL than NL; however, no differences in objective signs of phlebitis were noted. Of 773 episodes of positive blood cultures on study and control units, 6 (0.8%) were device-related (assessed by blinded investigator), with no difference between NL and CHL. Complications, including difficulty with infusion (P<.001) and disconnection of intravenous tubing from device (P<.001), were reported more frequently with CHL than with NL. Of nursing staff responding to a product evaluation survey, 95.2% preferred the study over control device. The projected annual incremental cost to our institution for hospitalwide implementation of NL for intermittent access for peripheral infusions was estimated at $82,845, or $230 per 1,000 patient days. CONCLUSIONS: A needleless intermittent intravenous access system with a reflux valve for peripheral infusions is effective in reducing percutaneous injuries to staff and is not associated with an increase in either insertion-site complications or nosocomial bacteremia. Institutions should consider these data, available institutional resources, and institution-specific data regarding the frequency and risk of intermittent access-device-related injuries and other types of sharps injuries in their staff when selecting the above or other safety devices. Copyright © The Society for Healthcare Epidemiology of America 1998 Mendelson Meryl H. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital Short Louise J. Department of Community Medicine, the Mount Sinai Hospital Schechter Clyde B. Department of Community Medicine, the Mount Sinai Hospital Meyers Burt R. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital Rodriguez Margarita Department of Nursing, the Mount Sinai Hospital, New York, New York Cohen Sandra Department of Nursing, the Mount Sinai Hospital, New York, New York Lozada John Mount Sinai School of Medicine of the City University of New York, New York DeCambre Marvalyn Mount Sinai School of Medicine of the City University of New York, New York Hirschman Shalom Z. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital Infection Control & Hospital Epidemiology Cambridge University Press 19/6(1998-06), 401-406 0899-823X 19:6<401 1998 19 ICE https://doi.org/10.1086/647839 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1086/647839 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mendelson Meryl H. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital NATIONALLICENCE 700 1- Short Louise J. Department of Community Medicine, the Mount Sinai Hospital NATIONALLICENCE 700 1- Schechter Clyde B. Department of Community Medicine, the Mount Sinai Hospital NATIONALLICENCE 700 1- Meyers Burt R. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital NATIONALLICENCE 700 1- Rodriguez Margarita Department of Nursing, the Mount Sinai Hospital, New York, New York NATIONALLICENCE 700 1- Cohen Sandra Department of Nursing, the Mount Sinai Hospital, New York, New York NATIONALLICENCE 700 1- Lozada John Mount Sinai School of Medicine of the City University of New York, New York NATIONALLICENCE 700 1- DeCambre Marvalyn Mount Sinai School of Medicine of the City University of New York, New York NATIONALLICENCE 700 1- Hirschman Shalom Z. Division of Infectious Diseases, Department of Medicine, the Mount Sinai Hospital NATIONALLICENCE 773 0- Infection Control & Hospital Epidemiology Cambridge University Press 19/6(1998-06), 401-406 0899-823X 19:6<401 1998 19 ICE CC0 http://creativecommons.org/publicdomain/zero/1.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-cambridge