Methods for microbial needleless connector decontamination: A systematic review and meta-analysis

Ms Julie Flynn1,2, Ms Emily Larsen1, Prof Samantha Keogh3, Dr Amanda Ullman1, Dr Li Zhang, Prof Claire Rickard1

1Griffith University, Nathan, Australia
2RBWH, Herston, Australia, 3QUT, Herston, Australia


Background: Post-insertion management of vascular access devices is essential for the prevention of bloodstream infection. The most commonly used method for needleless connector (NC) decontamination is a 70% alcohol wipe, however there is little evidence for any method. The objective of this review was to assess the various products used for NC decontamination on vascular access devices to minimise the risk of bloodstream infection in all patient populations.

Methods: A systematic search was conducted in CINAHL, Cochrane Central Register of Controlled Trials, Medline and PubMed to May 2018. The primary outcome was bloodstream infection and included peer reviewed published research, in English, in the NC decontamination on human subjects.

Results: Fourteen studies met the inclusion criteria. All the studies where pre-test/post-test design. These studies concluded that the alcohol wipe was inadequate for NC decontamination. Three studies from each group where included in the meta-analysis. For the chlorhexidine wipe group, and the pooled Risk Ratio was 0.40 [95% Confidence interval [CI] 0.18, 0.89]. In the alcohol impregnated cap group, the pooled RR was 0.46 [95% CI 0.23, 0.92].

Conclusion: Seventy percent alcohol wipe is commonly used on NCs prior to healthcare workers accessing the venous system; however, this review suggests that the alcohol wipe is inferior to the 70% alcohol impregnated cap and the CHG wipe. These results need to be taken with caution due to the small sample sizes and pre-test/post-test design. The best method for NC decontamination is not yet established and further high-quality research is needed.


Julie is a Registered Nurse in the haematology/bone marrow transplant unit at the Royal Brisbane and Women’s Hospital and a Senior Research Assistant at the Griffith University. She has been passionate about infection control practices when using a vascular access and especially the decontamination of the needleless connector.

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