Decontamination methods of needleless connectors in central venous access: a randomized controlled trial

Needleless connectors (NCs) are essential for central venous access but can cause bloodstream infections if contaminated. Currently, inconsistent guidelines on the optimal disinfectant and duration for NCs hinder nursing practice standardization. Notably, 75% ethanol, which is widely used in China, lacks rigorous comparison with 2% chlorhexidine gluconate (CHG) in ethanol, with existing evidence predominantly from intensive care units rather than outpatient settings.

To compare the decontamination efficacy of 75% ethanol and 2% CHG in ethanol with scrub durations of 5, 10, and 15 s on NCs in outpatients.

Using a factorial randomized controlled trial design, 360 NCs from 111 adult cancer patients with central venous access were randomized to six protocols: 75% ethanol or 2% CHG in ethanol, each scrubbed for 5, 10, or 15 s. Baseline and post-decontamination samples were collected for microbial culture to assess decontamination efficacy.

Baseline contamination occurred in 80.6% of 356 NCs, with brachial vein catheterization increasing risk (odds ratio: 3.12; 95% confidence interval: 1.20-8.12) and prolonged indwelling (>6 months) reducing it (0.25; 0.07-0.88). No significant difference was observed between 75% ethanol and 2% CHG in ethanol (P > 0.05). However, 15 s scrubbing achieved superior efficacy versus 5 s and 10 s protocols (P = 0.024).

This study found 75% ethanol equivalent to 2% CHG in ethanol for disinfection, supporting ≥15 s scrubs but noting residual contamination risks. By contextualizing disinfection protocols for outpatient populations and 75% ethanol-based practices, this study provides actionable evidence to standardize scrub durations and optimize resource allocation in diverse clinical settings.