Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

Table 2

Needleless connector literature.

	Grade^*
(1) E. Bouza et al., J Hosp Infect, vol.54, no. 4, pp. 279–287, 2003.	B
(2) B. Caillouet, J Assoc Vasc Access, vol.17, no. 2, pp. 86–89, 2012.	C
(3) D. Cain and G. Jones, “Comparison of catheter occlusions between a mechanical valve injection cap and positive displacement injection cap,” Poster NHIA, Dallas, Tex, USA, April 12–15, 2010.	C
(4) A. L. Casey, S. Burnell et al., J Hosp Infect, vol. 65, no. 3, pp. 212–218, 2007.	B-C
(5) A. L. Casey, T. Worthington, P. A. Lambert, D. Quinn, M. H. Faroqui, and T. S. Elliott, J Hosp Infect, vol. 54, no. 4, pp. 288–293, 2003.	B-C
(6) C. Chernecky and J. Waller, J Adv Nsg, vol. 67, no. 7, pp. 1601–1613, 2011.	D
(7) C. C. Chernecky, D. Macklin, W. R. Jarvis, and T. V. Joshua, AJIC, vol. 42, no. 2, pp. 200–202, 2014.	B-C
(8) S. Cicalini, F. Palmieri, and N. Petrosillo, Critcal Care, vol. 8, pp. 157–162, 2004.	B-C
(9) J. M. Costello, D. F. Morrow et al., Pediatrics, vol. 121, pp. 915–923, 2008.	C
(10) ECRI Institute, “Evaluation: needleless connectors,” Health Devices, vol. 37, no. 9, pp. 261–281, 2008.	D
(11) C. E. Edmiston, V. Markina, AJIC, vol. 38, pp. 421–423, 2010.	D
(12) F. Esteve, M. Pujol, E. Limon et al., Journal of Hospital Infection, vol. 67, no. 1, pp. 30–34, 2007.	B-C
(13) Hadaway L., J Assoc Vasc Access, vol. 16, no. 1, pp. 20–33, 2011.	D
(14) M. Ishizuka, H. Nagata, K. Takagi, and K. Kubota, Int Surg, vol. 98, pp. 88–93, 2013.	C
(15) W. Jarvis, C. Murphy, K. Hall et al., Clin Infect Dis, vol. 49, no. 12, pp. 1821–1827, 2009.	C
(16) N. Khalidi, D. S. Sovacevich, L. F. Papke-O’Donnell, and I. Btaiche, J Assoc Vasc Access, vol 14, no. 2, pp. 84–91, 2009.	C
(17) B. S. Niël-Weise, T. J. Daha, P. J. van den Broek, J Hosp Infect, vol. 62, no. 4, pp. 406–13, 2006.	A
(18) C. Salgado, L. Chinnes, T. Paczesny, and J. Cantey, Infect Control Hosp Epidemiol, vol. 28, no. 6, pp. 684–688, 2007.	C
(19) S. Schilling, D. Doellman, N. Hutchinson, and B. R. Jacobs, J Paren Ent Nut, vol. 30, no. 2, pp. 85–90, 2006.	B-C
(20) R. J. Sherertz, T. B. Karchmer, E. Palavecino, and W. Bischoff, European J Clin Micro Infect Dis, vol. 30, no. 12, pp. 1571–1577, 2011.	C
(21) L. Steininger, “In search of zero: eight years of interventions lead to reduced central line associated bloodstream infection rates,” Poster 5th Decennial International Conference on Healthcare-Associated Infections, Organized by SHEA, CDC, APIC, and IDSA, Atlanta, Ga, USA, March 2010.	C
(22) Y. P. Tabak, W. R. Jarvis, X. Sun, C. T. Crosby, and R. S. Johannes, Am J Infect Control, vol. 42, no. 12, pp. 1278–1284, 2014.	A
(23) J. C. Yébenes, R. Martínez, M. Serra-Prat et al., Am J Infect Control, vol. 31, no. 8, pp. 462–464, 2003.	D
(24) J. C. Yébenes, L. Vidaur, M. Serra-Prat, J. M. Sirvent, J. Batlle, M. Motje, A. Bonet, and M. Palomar, Am J Infect Control, vol. 32, no. 5, pp. 291–295, 2004.	B

Grade of recommendation was modified from the NHMRC definitions (NHMRC, 2009) [102]. To achieve a grade of A the research is required to be a high quality randomized control trial (RCT) or a systematic review of high quality RCTs. Laboratory (in vitro) research was classified as level V evidence (DeVries and Berlet 2010 [103]; The University of Newcastle Australia, 2014 [104]).
A: body of evidence can be trusted to guide practice, systematic review or RCT.
B: body of evidence can be trusted to guide practice in most situations, RCT or high quality observational study.
C: body of evidence provides some support for recommendation but care should be taken in its application, observational studies.
D: Level V evidence or evidence that is weak and recommendation must be applied with caution, expert opinion, animal, or laboratory studies.
See Figure 1.