Disinfection Cap for Needleless IV Connectors Provides Reduction in Bloodstream Infections

Early results of a prospective, peer-reviewed clinical trial demonstrated SwabCap® improved disinfection and allowed for reduced central line-associated bloodstream infection (CLABSI) rates by more than 79 percent in a four-hospital system according to a scientific poster presented at the recent scientific meeting of the Society for Healthcare Epidemiology of America (SHEA).

Contamination of the patients catheters was greatly reduced by switching to the disinfection cap for needleless IV connectors, said researchers at NorthShore University HealthSystem (Evanston, Ill.).

The improved disinfection and reductions in contamination were achieved with SwabCap use on all central lines, even though the hospitals already had a low CLABSI rate of 1.95 per 1,000 catheter days before introduction of the disinfection cap.

"This is by far the most extensive study data on the disinfection cap to date. It leads us to conclude that the device shows considerable promise as a tool for reducing CLABSIs," says Marc-Oliver Wright, MT(ASCP), MS, CIC, lead author and the director of infection control at NorthShore University HealthSystem. "There was a statistically significant reduction in intraluminal contamination when the cap was used, which likely explains the favorable impacts on CLABSIs."

In addition to lower CLABSI rates, researchers also reported on the density of the colony-forming units in blood samples, as another way to compare the disinfection cap to the manual, alcohol pad method of connector disinfection. During the SwabCap phase, there was a reduction of 75 percent in the average number of colony forming units counted in the samples.

SwabCap is a simple twist-on device that is intended to be used between catheter-line accesses as a supplement to manual disinfection. The FDA-cleared device passively disinfects the connector top and threads. It can only be attached to the connector one way, which helps eliminate variation.

As the cap is twisted onto the threads, a foam pad inside the cap is compressed, releasing 70 percent isopropyl alcohol that continually bathes the top and threads while the cap is in place. The twisting action and the patent-pending thread cover design help focus the alcohol on the targeted areas. The cap also acts as a physical barrier to touch and airborne contamination, lasting up to 96 hours under normal conditions if not removed.  Finally, the cap improves compliance because when the bright orange cap is observed in place on the connector, compliance is visually confirmed.

The poster presented at SHEA was titled "Continuous Passive Disinfection of Luer Access Valves to Prevent Contamination." In addition to Wright, study co-authors were Jackie Tropp, RN, MSN, Sue Boehm, RN, Donna M. Hacek, MT(ASCP), and Lance R. Peterson, MD, all of NorthShore. The SHEA annual scientific meeting was held April 1-4 in Dallas.

Excelsior Medical Corporation, the maker of SwabCap, recently received FDA 510(k) clearance for SwabFlush, the IV catheter flush syringe that provides a disinfection cap built into the plunger of the syringe. SwabFlush combines SwabCap and Excelsior's ZR pre-filled flush syringe so that a nurse accessing an IV catheter line can use the two SwabFlush components (saline flush syringe and SwabCap) to flush the line and cap it. SwabFlush replaces the final saline flush syringe. SwabFlush promotes compliance with required protocols for both catheter flushing and disinfection of IV connectors.

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