Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review

Table 6

	Recommendations for disinfecting practices	Levels of evidence^*
1	Use disinfection on surfaces of needleless connectors, stopcocks and other intravascular access ports immediately prior to any connection, infusion or aspiration with appropriate antiseptic agent (e.g., alcoholic chlorhexidine, povidone iodine, an iodophor, or 70% alcohol). Access catheter connections with sterile devices only [8–11].	B
2	Antimicrobial caps/port protectors may be effectively used for passive continuous hub disinfection on needleless connections in accordance with manufacturer instructions, in conjunction with frictional antiseptic wiping between applications and access [2, 6, 10, 12–51].	B-C
3	Ensure compliance with hand hygiene, gloving and aseptic practices prior to any contact with intravenous devices and add-on equipment [6, 8, 10, 30, 52–59].	B
4	Establish and educate all clinical staff on a standard protocol to disinfect catheter hubs, needleless connectors and ports prior to and after each access [11, 20, 60–63].	B-C
5	Provide consistent and varied staff education on consequences of poor technique along with clinical reminders of best practice [10, 13, 51, 54, 60, 64–87].	C
6	Establish regular surveillance of compliance for disinfection of intravascular devices prior to access with reporting of results to each care unit [1, 67, 72, 78, 88–96].	C
7	Establish a formal process to evaluate new technology and needleless connector designs [7, 71, 97, 98].	A
8	Implement a multimodal quality improvement infection prevention program that applies guidelines and recommendations to all intravascular practices [68, 78, 85, 99–101].	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.