523 : In-vitro Study Documenting the Lack of Antibacterial Activity of Three Silver-impregnated/coated Mechanical Valve Needleless Connectors After Blood Exposure

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Cynthia C. Chernecky, PhD , Medical College of Georgia, Augusta, GA
William Jarvis, MD , Jason and Jarvis Associates, Hilton Head, SC
Jennifer Waller, PhD , Medical College of Georgia, Augusta, GA
Denise Macklin, BSN , Nurse Consultant, Marietta, GA
Background: In efforts to reduce risks of bloodstream infections some manufacturers coated/impregnated components of needleless connectors with silver ions.  Although silver has antibacterial properties, the impact on this activity when the connector comes in contact with proteins, e.g., blood, in an IV needleless connector is not known.

Objective: We conducted an in-vitro study to assess the antibacterial activity of needleless connectors impregnated with silver nanoparticles. Unlike the only previous such assessment (Maki, 2010) we exposed the internal connector surface to blood, as would commonly be done in the clinical setting and then exposed the connector to bacterial challenge and evaluated their antibacterial activity.

Methods: Using a high-efficiency particulate air-filtered hood, bovine blood was drawn-up into needleless connectors from three manufacturers, V-Link™ (Baxter, Deerfield, IL), Ultrasite® Ag™ (B.Braun, Bethlehem, PA) and MaxGuard™ (Medegen/CareFusion, Ontario, CA), until seen in the syringe, flushed then left untouched four hours.  This was repeated times three.  Two mls of 106 or 108 cfu/ml inoculum of Staphylococcus aureus or S. epidermidis was flushed through connectors, syringe removed, connectors incubated 15 hours. Connector tops disinfected with 70% alcohol, flushed with 5 mls DYNE neutralizer broth,directly plated or membrane filtered and plated. All plates incubated for 2 days at 37o + 2oC.  Plates scored for growth.  Four controls, positive, negative, neutralization, and no flush were included. Six of each connector were tested with both organisms (N =36).

Results: All three silver coated/impregnated connectors grew S. aureus and S. epidermidis.  Log reduction was not clinically significant, range +0.19 to -1.82.  There was substantial and escalating bacterial growth (Table1).

Table 1. Staphylococcus aureus and epidermidis Colony Forming Units.

Device

MG -SA

USSA

VLSA

MG -SE

US -SE

VL-SE

+ control = 0 hour

1.6x108

7.9x107

2.1x108

1.2x106

9.1x106

3.0x108

+ control = 15 h

3.9x108

1.4x108

Not Done/ND

4.4x107

2.6x107

ND

Non-flush

5.7x108

1.9x108

ND

1.0x107

3.5x106

ND

Neutralization

94%

106%

100%

96%

96%

50%

#1 connector

2.8x108

1.8x108

2.4x108

8.0x107

2.5x107

2.2x108

#2

1.2x108

7.6x108

2.0x108

5.4x107

4.4x106

5.2x108

#3

3.5x108

1.0x108

1.5x108

3.0x107

3.6x107

4.0x108

#4

1.5x108

1.2x108

1.4x108

7.8x107

5.9x106

3.9x108

#5

1.3x108

4.1x108

1.4x108

3.0x107

2.9x107

3.6x108

#6

3.0x108

2.9x108

1.8x108

5.7x107

2.5x107

5.1x108

Conclusions: Once blood comes in contact with silver-coated/impregnated needleless connectors their antibacterial activity becomes significantly reduced.  Since intravenous connectors are in frequent contact with blood, these connectors may not offer benefits over connectors that are not silver-impregnated/coated and should be further evaluated in clinical settings.