When new consumable products are introduced into clinical routine, appropriate methods are often lacking for showing possible advantages or disadvantages in a scientific reviewable manner. If such new materials are also associated with higher costs, the work process should be first analyzed in detail. In this way, possible benefits for staff and patients can be determined, and macroeconomic decisions can be taken. The importance of such “process analyses” for all processes in a hospital is also increasingly reflected in the literature [6, 8].
So far, new consumable products have been introduced in hospitals for a defined time period at which end the “test phase” was compared with the “pre-situation”. This process is time-consuming and often not reliable enough, because staff members have to familiarize themselves with the new product only for a short period of time, which often results in motivation problems that may negatively affect final results.
A simulation compiled by a few employees only, who become “integrated” into the process, creates a reliable description of work processes and work analysis. This description can be converted into a software-supported simulation that can be run so frequently that it corresponds to actual conditions.
Apart from saving time, the simulation also helps to analyze own operational sequences with regard to possible optimizations, as such simulations are necessary for the introduction of standard operation procedures (SOP) in the context of quality management.
An analysis of the work process with regard to the intervention at the middle port (C-port) of a TWC followed by a simulation of 1000 interventions should first show if working time for staff could be reduced with the new consumable product. Secondly, the analysis should determine the intervention threshold from which possible higher initial costs of a new product in comparison to a conventional system are justified as well as other possible advantages.
By measuring the contamination level of the two products, we could not only show cost efficiency benefitting hospitals but also benefits for patients. Such analyses should first and foremost focus on patient safety. In their paper “Scrub the Hub” on infection due to contamination of central venous catheters (CVC), Lockman et al.  stressed that interventions carried out according to high hygienic standard is the foremost prerequisite for avoiding CVC infections. The cleaning intensity as well as the technical condition of the connecting material before and after the intervention is crucial. The poorer the cleaning, the less accessible or more complex the material, the poorer is the quality of disinfection. In daily clinical routine especially, work intensification may result in neglecting the essential waiting period after C-port disinfection.
A retrospective multi-center study by Hetem et al.  showed a high rate of contamination of central venous catheters at different connection sites with Staphylococcus aureus; up to 12% of patients suffered from bacteremia after CVC removal. The contamination rate indicated in the trial of Casey et al.  with a contamination rate of 10% for the internal surfaces of TWC luers with standard caps correspond with the data obtained in our observation. It might be objected that our observation was not a prospective, randomized trial and reports only experience at a single institution.
Above all, it is remarkable that the contamination of the TWC’s was already detectable after a very short retention time. The presence of gram-negative bacteria indicates that contamination is not only caused by typical skin flora but also by bacteria with a higher pathogenic potential.
The impact of using needle-free connecting systems for nosocomial infections has been examined in several trials. Salgado et al.  could reduce a high level of bacteremia after changing Split septum systems (similar to the luer access split septum system used here) to systems with mechanical flaps (5.95 vs. 1.79 per 1000 catheter days, RR 3.32, p<0.001). In a multi-center trial, Jarvis et al.  also found a significant increase of the rate of bacteremia when using systems with mechanical flaps compared with Split septum systems or needles (9.49 vs. 6.15 per 1000 CVC days, RR 1.54, p<0.001). Additionally, the authors could also show the benefit of Split septum systems, as in the second phase of the trial a change of systems significantly decreased infection rates (9.49 vs. 5.77 per 1,000 CVC days, RR 1.65, p<0.001). Basically, a central venous catheter is a risk factor  for hospital-associated bacteremia; therefore, every intervention of a catheter system necessitates a high level of hygiene.