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Evaluating methods for the use and decontamination of needleless connectors: A qualitative inquiry

  • Emily N. Larsen
    Correspondence
    Corresponding author. Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Level 2, Building 34, Cnr. Bowen Bridge Rd and Butterfield St, Herston QLD 4029, Australia. Fax: +617364658332
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
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  • Deanne August
    Affiliations
    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
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  • Samantha Keogh
    Affiliations
    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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  • Julie Flynn
    Affiliations
    School of Nursing and Midwifery, University of Southern Queensland, Ipswich, Queensland, Australia
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  • Amanda J. Ullman
    Affiliations
    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia

    Children's Health Queensland, Brisbane, Queensland, Australia
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  • Nicole Marsh
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia

    Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

    Patient-Centred Health Services, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia

    School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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  • Marie Cooke
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia
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  • Alexandra L. McCarthy
    Affiliations
    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia

    Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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  • Claire M. Rickard
    Affiliations
    School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia

    Alliance for Vascular Access Teaching and Research Group, Griffith University, Brisbane, Queensland, Australia

    School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia

    Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
    Search for articles by this author

      Highlights

      • Needleless connectors are a safety device for staff (reducing needlestick injuries) and patients (barrier to infection).
      • Needleless connector practices are repeated routines/‘rituals;’ participants were not always aware of best practice or guidelines.
      • Nomenclature surrounding needleless connector brands and function is diverse and confusing for practitioners.
      • Participants were more careful with needleless connectors attached to central venous devices, compared to peripheral devices.

      Abstract

      Background

      Needleless connectors (NCs) are essential devices designed to provide safe, needle-free connection between venous access devices, syringes and infusions. There is a variety of designs, and associated decontamination products and practices; the resulting confusion can cause detrimental patient outcomes. This study aimed to explore nurses’ attitudes, techniques, and practices around the use and decontamination of NCs in clinical practice.

      Methods

      Qualitative inquiry was conducted with seven focus groups of 4–6 participants each in the cancer and surgical units of a large tertiary hospital in Australia between January and March 2019. Participants comprised nurses who had taken part in a recent clinical trial of NC decontamination. Focus group sessions were recorded, transcribed and synthesised using content analysis.

      Results

      Seven focus groups were conducted (total, N = 30 participants), lasting 16–20 min. Six major themes were identified surrounding needleless connector use and decontamination: ‘safety and utility’; ‘terminology and technological understanding’; ‘clinical practice determinants’; ‘decontamination procedures and influencers’; ‘education and culture’; and ‘research and innovation’.

      Conclusion

      The participants articulated positive attitudes towards needleless connector use for needle-stick and infection prevention, however rationales for care and maintenance practices demonstrated limited understanding of guidelines (e.g., disinfection time) and specific NC function (e.g., positive, negative pressure). The findings indicated the need for targeted, standardised needleless connector education, to enhance staff confidence, improve consistency of care and ensure patient safety.

      Keywords

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