New research reports that the SwabCap® disinfection cap for luer access valves helped hospitals meet several challenges with IV valve disinfection and Joint Commission-related compliance. A separate study concluded that the device passively disinfects luer access valves after only five minutes of connection. The research will be presented as scientific posters at the upcoming AVA 2010, the annual scientific meeting of the Association for Vascular Access (AVA).
Two of the posters are from hospitals that were having trouble ensuring their nurses were following patient-safety protocols for disinfecting luer access valves. Incomplete disinfection increases the risk of central line-associated bloodstream infections (CLABSI), which are potentially fatal and cost $34,000 or more each to treat.
One of new posters is from MacNeal Hospital, a 427-bed facility in Berwyn, Ill. MacNeal had a CLABSI rate of 4.2/1000 catheter days despite an initiative focused on eliminating these infections. SwabCap was trialed and then broadly implemented after analysis suggested that poor compliance with the hospital's valve disinfection protocol might be the primary cause for the problem.
Prior to adopting SwabCap, MacNeal used a common, older disinfection method, which involves scrubbing the valve hub and port with alcohol.
Since SwabCap's implementation, CLABSIs have been totally eliminated in MacNeal's ICU, according to the posters five months of data available since implementation of the disinfection cap. Hospital-wide, the CLABSI rate has dropped to 0.94/1,000 catheter days, a much lower number compared to national averages over the same period.
"We were searching for an engineered work practice solution to our valve disinfection process a solution that would make it easy for nurses to comply with our protocol and easy for supervisors to confirm compliance," said Therese Antony, RN, CIC, co-author of the poster and MacNeal's infection protectionist during the time SwabCap was implemented. Mark Levin, MD, is the other co-author of the MacNeal poster.
"By replacing our valve-swabbing policy with this well-designed device, we achieved our aim," Antony said. "The sharp reduction in our CLABSI rate confirmed both our suspicion about the source of the problem and the wisdom of the disinfection cap solution."
The second hospital poster concerns a similar situation. Weiss Memorial Hospital, a 339-bed institution in Chicago, also suspected poor compliance with its valve disinfection protocol. Prior to adopting SwabCap, Weiss used the same protocol as MacNeal.
Weiss solved the compliance problem by adopting SwabCap hospital-wide after trialing the device for two weeks. Co-authors of the poster are Antony and Gerri Kaye, RN, MS, CCRN, APN.
The third poster, by Nancy Moureau, RN, BSN, CRNI, CPUI, reports the results of an in vitro study designed to test SwabCap's ability to passively disinfect luer access valves. The study was prompted in part by research reporting that 31 percent of nurses did not disinfect valves before accessing the lines.
In the study, six different kinds of luer access valves were inoculated with four organisms associated with catheter-related bloodstream infections. SwabCap was then attached to the valves for five minutes.
The poster reports: "Passive (non-scrubbing) disinfection using the cap was achievable on the connectors and organisms tested after five minutes of attachment."
"The process of disinfection can be achieved both through active means by scrubbing over a short time, and passively by adding more time and contact with the disinfecting agent." Moureau said. "This study demonstrates that SwabCap achieves adequate disinfection by bathing the valve top in alcohol and keeping it covered."
Moureau is founder of PICC Excellence, a training, educational and consulting company.
SwabCap is a simple twist-on device that disinfects swab-able luer access valves (needleless IV connectors) in between line accesses. The FDA-cleared device passively disinfects the valve top and threads while providing a physical barrier to contamination.
SwabCap disinfects luer access valves by bathing the valves threads and top with 70% isopropyl alcohol. As the cap is twisted onto the threads, a foam pad inside the cap is compressed, releasing the alcohol. The twisting action and the patent-pending thread cover design help focus the alcohol on the targeted areas, without activating the luer access valve. The cap also acts as a physical barrier to touch and airborne contamination, lasting up to 96 hours under normal conditions if not removed.
AVA 2010 will be held Sept. 24-26 in National Harbor, Md.