Quantitative assessment of reflux in commercially available needle-free IV connectors.

INTRODUCTION: Blood reflux is caused by changes in pressure within intravascular catheters upon connection or disconnection of a syringe or intravenous tubing from a needle-free connector (NFC). Changes in pressure, differing with each brand of NFC, may result in fluid movement and blood reflux that can contribute to intraluminal catheter occlusions and increase the potential for central-line associated bloodstream infections (CLABSI). METHODS: In this study, 14 NFC brands representing each of the four market-categories of NFCs were selected for evaluation of fluid movement occurring during connection and disconnection of a syringe. Study objectives were to 1) theoretically estimate amount of blood reflux volume in microliters (µL) permitted by each NFC based on exact component measurements, and 2) experimentally measure NFC volume of fluid movement for disconnection reflux of negative, neutral and anti-reflux NFC and fluid movement for connection reflux of positive displacement NFC. RESULTS: The results demonstrated fluid movement/reflux volumes of 9.73 µL to 50.34 µL for negative displacement, 3.60 µL to 10.80 µL for neutral displacement, and 0.02 µL to 1.73 µL for pressure-activated anti-reflux NFC. Separate experiment was performed measuring connection reflux of 18.23 µL to 38.83 µL for positive displacement NFC connectors. CONCLUSIONS: This study revealed significant differences in reflux volumes for fluid displacement based on NFC design. While more research is needed on effects of blood reflux in catheters and NFCs, results highlight the need to consider NFCs based on performance of individual connector designs, rather than manufacturer designation of positive, negative and neutral marketing categories for NFCs without anti-reflux mechanisms.

Foaming Betadine Spray as a potential agent for non-labor-intensive preoperative surgical site preparation.

BACKGROUND: The Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) report published in 2009 shows that there were about 16,000 cases of surgical site infection (SSI) following ~ 850,000 operative procedures making SSI one of the most predominant infection amongst nosocomial infections. Preoperative skin preparation is a standard procedure utilized to prevent SSIs thereby improving patient outcomes and controlling associated healthcare costs. Multiple techniques/ products have been used for pre-operative skin preparation, like 2 step scrubbing and painting, 2 step scrubbing and drying, and 1 step painting with a drying time. However, currently used products require strict, time consuming and labor-intensive protocols that involve repeated mechanical scrubbing. It can be speculated that a product requiring a more facile protocol will increase compliance, thus promoting a reduction in SSIs. Hence, the antimicrobial efficacy of a spray-on foaming formulation containing Betadine (povidone-iodine aerosol foam) that can be administered with minimum effort is compared to that of an existing formulation/technique (Wet Skin Scrub). METHODS: In vitro antimicrobial activities of (a) 5% Betadine delivered in aerosolized foam, (b) Wet Skin Scrub Prep Tray and (c) liquid Betadine are tested against three clinically representative microorganisms (S. aureus, S. epidermidis and P. aeruginosa,) on two surfaces (agar-gel on petri-dish and porcine skin). The log reduction/growth of the bacteria in each case is noted and ANOVA statistical analysis is used to establish the effectiveness of the antimicrobial agents, and compare their relative efficacies. RESULTS: With agar gel as the substrate, no growth of bacteria is observed for all the three formulations. With porcine skin as the substrate, the spray-on foam's performance was not statistically different from that of the Wet Skin Scrub Prep technique for the microorganisms tested. CONCLUSIONS: The povidone-iodine aerosolized foam could potentially serve as a non-labor intensive antimicrobial agent for surgical site preparation.

Sunlight-assisted route to antimicrobial plasmonic aminoclay catalysts.

We present a straightforward, environmentally-benign, one-pot photochemical route to generate alloyed AgAu bimetallic nanoparticle decorated aminoclays in water at room temperature. The protocol uses no reducing agent (e.g., NaBH4) nor is photocatalyst required. These hybrid materials show excellent promise as dual catalysts/antibacterial agents.