Impact of needleless connectors in closed infusion systems on the occurrence of bloodstream infection related to the use of central venous catheters: evidence from a systematic review / Impacto do uso de conectores sem agulha para sistema fechado de infusão na ocorrência de infecção de corrente sanguínea relacionada ao cateter venoso central: evidências de uma revisão sistemática

Silvia Helena Frota Mendonça

Needleless connectors were introduced to reduce the incidence of needlestick injuries in health professionals and according to the literature their effectiveness is irrefutable. However, there is no conclusive evidence on the advantages of needleless connectors for patients with regard to bloodstream infection rates from the use of central venous catheters. The objective of this study was to determine the impact of the use of needleless connectors in closed infusion systems on the occurrence of bloodstream infections related to the use of central venous catheters by conducting a Cochrane systematic review. The strategy for searching electronic databases employed the components of the PICO model: Population (studies of patients using central venous catheters, regardless of age, sex, race and associated health service); Intervention (use of closed needleless connector systems, with and without valves, with and without positive pressure); Comparison (use of plugs, closed system connectors with and without needles, with and without valves, with and without positive pressure); Outcome (bloodstream infection, cannula contamination, microbial contamination, bloodstream infection related to catheter). The electronic databases investigated were: PubMEDLINE, OVID, EMBASE, LILACS and CINAHL. Bibliographical references of the studies included were also evaluated. The results are presented in three stages: characterization of selection process for studies found in the search; characterization of studies included in the systematic revision; evaluation of quality and strength of evidence for studies included according to the Jadad Scale and the scale of quality of studies in the control and prevention of bloodstream infections related to central venous catheters. The sample of this systematic review was made up of 14 studies of which 4 investigated only needleless connectors. We found 6 randomized control clinical trials, 4 cohort, 3 case-control and 1 therapeutic result. Bloodstream infection related to central venous catheters was the outcome for 9 studies. Six presented differences regarding the valved connector; 04 in favor of the puncturable connector with cannula; 01 in favor of the puncturable connector with needle; 01 in favor of the valved connector with positive pressure and 02 in favor of the device used before the change. The heterogeneous nature of the studies with regard to design, population characteristics and controlled risk factors and results prevented a meta-analysis. However, it is possible to state, based on the four best studies found, that the introduction of needleless connectors, whether valved or puncturable with cannula, coupled with a closed infusion system, presented a positive impact on lowering contamination of catheter cannulae and on the occurrence of bloodstream infection related to central venous catheters

AUTOR(ES)

DATA DE PUBLICAÇÃO

RESUMO

ASSUNTO(S)

ACESSO AO ARTIGO

Documentos Relacionados