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After insertion of a catheter, introduction of microorganisms occurs primarily from two routes: the skin/insertion track or through the lumen of the catheter [15, 124�C127]. The greatest risk for contamination of the catheter after insertion is the access hub with 33�C45% (402/900) contaminated in normal patient use [6, 15, 128�C132]. In early studies by Sitges-Serra colonization of the catheter hub was considered the primary pathogenesis of catheter associated infection [15, 113]. Linares and colleagues reported 14 episodes of sepsis (70% of total catheter related septic events) resulted from hub-related contamination [127, 133]. Moro reported hub colonization in only 3.5% (21/607), but found that this group was responsible for severe systemic infections more frequently Selleck GDC-0449 [128]. Studies indicate that, during periods of nonuse, colony forming units (CFU) are present on access hubs in numbers ranging from 15 to 1000?CFU, representing quantities sufficient to cause contamination, biofilm formation, and potentially bacteremia if not sufficiently disinfected prior to access [3, 5, 12, 99, 110, 111, 134�C143]. As demonstrated by multiple studies, infections are drastically lower or eliminated by disinfecting or covering the access hub with an antimicrobial cap [14, 16�C20, 113, 127, 144�C146]. Hub contamination plays an increasingly important role with infection risk the longer the catheter selleck chemicals llc is in place [15]. Intraluminal contamination and subsequent Quinapyramine colonization become more prominent with longer dwell times [110, 147]. Perez and associates found 59% (42/75) of one group of NC colonized with biofilm and Salzman found that 71% (20/28) of catheter related infections originated in the catheter hub presumably from contamination [15, 21, 22, 148]. Clearly hub contamination is a causative element in catheter related infections and one that demonstrates the necessity for effective hub disinfection prior to access [110, 113, 127, 133, 144, 149]. 3.2. What to Disinfect? Disinfection points to gain access to intravenous or intravascular devices may include tubing side ports, direct catheter connections, stopcocks with needle free caps, NC of various types (split septum, mechanical valves, positive pressure valves, zero, or neutral connectors), traditional silicone septum, or other forms of access integrated with the catheter or tubing. Any intravascular access point with a surface open to the environment requires disinfection prior to use, as it acts as the immediate portal of entry for intraluminal contaminants [23, 99, 113, 127, 133, 144, 150�C152].
