Garcia, et al.A Study of the Effects on Bacteremia and Sharps Injury Rates after Introduction of an Advanced Luer Activated Device (LAD) for Intravascular Access in a Large Hospital Setting.AJIC: June 2007; 35(5); E75

This study compares an Advanced Luer Activated Device (Flo-Link®, aka MaxPlus Clear™ Positive Displacement Connector) to the same Split Septum device associated with low BSI rates in three of the four studies referenced by the SHEA/IDSA recommendation. The results of this study state:

• “At 95% confidence intervals, p values did not indicate a significant difference in the BSI rates in the SSD or LAD groups in patients with peripheral and central lines. Sharp injuries related to IV port access were reduced from four during the Group 1 (SS period) to zero during the Group 2 period.”
• “The complexity of the design appears to be associated with an increase in bacterial transfer in many of the currently manufactured mechanical valves…The results of this study suggest that the use of an advanced LAD in coordination with adherence to proper infection control practice does not contribute to increases in either BSI rates or sharp injuries.”³
  

What specific connector features reduce infection risk?

• Smooth, flat and tightly sealed access port complete disinfection
• No intricate surface details, nooks, or crannies no areas to harbor bacteria
• Visible fluid path allows for complete flushing
• Simple design minimal parts to obscure fluid path

What additional features does the Advanced Luer Activated Device offer that simpler connectors do not?

• Positive displacement pulse helps prevent reflux occlusion
• Saline only flush reduces the use of heparin and associated heparin risks

References:
1. Marschall, Jonas MD et al. Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals Infection Control and Hospital Epidemiology, October 2008, Volume 29,
Supplement 1
2. Jarvis, W. MD, et al. Increased central venous catheter-associated bloodstream infection rates temporarily associated with changing from a split-septum to a luer access mechanical valve needleless device: A nationwide outbreak? American Journal of Infection Control June 2005, Volume 33, Number 5 and Presentation at AVA 19th Annual Conference
3. Garcia, et al. A Study if the Effects on Bacteremia and Sharps Injury Rates after Introduction of an Advanced Luer Activated Device (LAD) for Intravascular Access in a Large Hospital Setting Abstract/Poster presented at APIC Conference 2007
4. Costello, et al. Systematic intervention to reduce central line-associated blood-stream infections rates in a pediatric cardiac intensive care unit.Pediatrics 2008; 121:915-923