Highlights
- •Survey of nurses' knowledge and practice of NC care.
- •89% of nurses clean NCs each time before access.
- •25% of nurses correctly recognized negative pressure NCs, 79% chose the correct clamping sequence.
- •44% of nurses correctly recognized positive pressure NCs, 34% chose the correct clamping sequence.
- •Nurses reported their behaviour is most influenced by local senior nurses.
Abstract
Background
Inappropriate needleless connector (NC) care is associated with device failure from
catheter occlusion and patient blood stream infections (BSIs). This can be attributed
to a lack of knowledge of connector designs and flushing, clamping, and syringe disconnection
techniques. This study aimed to assess nurses’ practice, knowledge, attitudes, and
key influencers on appropriate care of NCs in an Australian facility and compare these
with studies undertaken in the United States in 2011.
Methods
A cross-sectional online survey was sent via email with a SurveyMonkey® link to all
nurses working in clinical areas (total population sampling approach; approximately
1500 nurses), at an Australian hospital, in 2018. The survey was anonymous and open
for 6 weeks. Analysis was with R software.
Results
Response rate was approximately 19% (n = 283). Most (89%) of nurses stated that they
clean NCs before each access. Only 25% correctly recognised the negative pressure
NC, and 79% correctly identified the correct clamping and disconnection sequence.
Positive pressure displacement devices were correctly identified by 44% of respondents,
with 34% identifying the correct clamping and disconnecting technique. Nurses reported
their behaviour was most influenced by local senior nurses.
Conclusions
There remains a significant gap in nurses' knowledge of NC device types, as well as
the correct clamping and syringe disconnection for both negative and positive displacement
NCs. This survey reaffirms that senior nurses are the key influencers of nurses’ adherence
to best practice guidelines.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Infection, Disease & HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Preventing needlestick injuries in health care settings.Department of Health and Human Services, 1999 (Retrieved June 8, 2020 from)
- Disinfection of needleless connector hubs: clinical evidence systematic review.(2015) Nursing Research and Practice, 2015https://doi.org/10.1155/2015/796762
- Outbreak of bloodstream infection temporally associated with the use of an intravascular needleless valve.Clin Infect Dis. 2007; 44: 1408-1414https://doi.org/10.1086/517538
- Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port.Infect Contr Hosp Epidemiol. 2006; 27: 67-70https://doi.org/10.1086/499166
- Incidence of catheter-related bloodstream infection among patients with a needleless, mechanical valve-based intravenous connector in an Australian hematology-oncology unit.Infect Contr Hosp Epidemiol. 2007, May; 28: 610-613https://doi.org/10.1086/516660
- Update: catheter-related bloodstream infection rates in relation to clinical practice and needleless device type.Can J Infect Contr. 2008; 23 (162): 156-160
- Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital.Infect Contr Hosp Epidemiol. 2007; 28: 684-688https://doi.org/10.1086/516800
- Needleless connectors for IV catheters.Am J Nurs. 2012; 112: 32-46https://doi.org/10.1097/01.NAJ.0000422254.18578.a8
- Safe patient care when using vascular access devices.Br J Nurs. 2013; 22 (S14, S16, S18)https://doi.org/10.12968/bjon.2013.22.Sup1.S14
- Choosing the best design for intravenous needleless connectors to prevent healthcare-associated bloodstream infections.Infect Contr Today. 2010; 14: 1-3
- Needleless connectors: improving practice, reducing risks.J Assoc Vasc Access. 2011; 16: 20-33https://doi.org/10.2309/java.16-1-4
- Flushing and locking of venous catheters: available evidence and evidence deficit.Nurs Res Pract. 2015; 1–9 (2015) (Article 985686)https://doi.org/10.1155/2015/985686
- Infusion therapy standards of practice.J Infusion Nurs. 2016; 39: S1-S159
- Guidelines for the prevention of intravascular catheter-related infections.Clin Infect Dis. 2011; 52 (2017): e162-e193
- epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.J Hosp Infect. 2014; 86: S1-S70https://doi.org/10.1016/S0195-6701(13)60012-2
- Guide to the safe use of needlefree connectors.Br J Nurs. 2019; 28: 1-6https://doi.org/10.12968/bjon.2019.28.Sup14b.1
- Autonomy and self-efficacy as influencing factors in nurses' behavioral intention to disinfect needleless intravenous systems.J Infusion Nurs. 2011; 34: 193-200https://doi.org/10.1097/NAN.0b013e31821478e7
- Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey.Clin Microbiol Infect. 2016; 22 (812.e819-812.e817)https://doi.org/10.1016/j.cmi.2016.06.014
- A language and environment for statistical computing.R Foundation for Statistical Computing, 2020
- Peripheral Intravenous Cannulation (PIVC) – Insertion and management (PAH01585/v13/10/2020).Metro South Health, 2020
- SmartSite® needle-free valve user's guide. CareFusion.2010 (Retrieved 3 May, 2020, from)
- How clinical champions can improve quality.Nurs Manag. 2008; 14
- Characteristics of quality improvement champions in nursing homes: a systematic review with implications for evidence-based practice.Worldviews Evidence-Based Nurs. 2017; 14: 440-446
- Surveying nurses:identifying strategies to improve participation.Eval Health Prof. 2011; 34: 487-511https://doi.org/10.1177/0163278711399572
Article info
Publication history
Published online: May 27, 2021
Accepted:
April 25,
2021
Received in revised form:
April 14,
2021
Received:
December 19,
2020
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier B.V. on behalf of Australasian College for Infection Prevention and Control. All rights reserved.
