Multi-Site Study Examines Role of IV Disinfection Cap in Catheter Bundle

A disinfection cap used in IV therapy was the subject of an award-winning, multi-site study at a four-hospital Chicago-area hospital system.

The study, Continuous Passive Disinfection of Luer Access Valves to Prevent Contamination, was reported in an oral presentation at the recent annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

The presenter and lead study author was Marc-Oliver Wright, MT (ASCP), MS, CIC, corporate director of infection control for NorthShore University HealthSystem (NorthShore), headquartered in Evanston, Ill.

As a result of our findings, our organization chose to adopt the disinfection cap as part of our standard operating procedure for the prevention of CLABSIs, Wright says.

Disinfection cap use was also the focus of a second presentation at the conference, regarding its application to a vulnerable pediatric population at St. Marys Hospital for Children, in Bayside, N.Y.

In the NorthShore study, Wright and colleagues examined the effect of incorporating an alcohol disinfecting cap into the catheter maintenance bundle. CLABSIs were observed to decline in the health system by a total of 51 percent with the new protocol.

The change in catheter protocol was determined to be cost-neutralizing by avoiding infections and associated additional length of stay, Wright says.

IV connectors help provide intravenous therapy to patients by connecting tubing to catheters. However, these connectors can be a source of potentially dangerous bacteria, according to the Centers for Disease Control and Prevention. Traditional disinfection of IV connectors involves manually scrubbing them with isopropyl alcohol (IPA) for 15 seconds. But this approach can be subject to risky variations and noncompliance.

The disinfection cap (SwabCap®) is designed to be twisted on and cover the top and sides of a needleless luer-lock IV connector. The cap bathes the connector with IPA when attached to the connector. The cap is also left in place between catheter accesses to protect against touch and airborne contamination.

Wrights study won a blue-ribbon prize from APIC. The abstract can be viewed at http://bit.ly/L2sTAS (registration required). APIC showcases the most significant scientific abstracts during its conference and recognizes the achievements of researchers and infection preventionists whose studies and presentations advance the practice. Blue Ribbon Awards are given to a limited number of abstracts based on their scientific and/or educational quality.

A revised protocol including a disinfection cap was also the focus of a second presentation at the APIC annual conference. Those findings examined a catheter protocol change for the vulnerable pediatric population at St. Marys Hospital for Children, in Bayside, N.Y. Patient vulnerabilities included short bowel syndrome, long-term intravenous nutrition, and the increased contaminants entailed by those circumstances.

The protocol change involved the addition of four preventive elements:

- An evidence-based foam patch (BioPatch®, Ethicon 360) that secretes chlorhexidine gluconate (CHG) at the catheter insertion site to combat skin flora;

- Scrubbing patients lines with chlorhexidine gluconate following diaper changes to reduce exposure to fecal bacteria;

- A protective vest the hospital invented to decrease the inherent risk of catheter displacement by restless pediatric patients;

- The disinfection cap.

With these four interventions deployed together, CLABSIs were observed to fall by 53.1 percent.

The posters authors were Marianne Pavia, MT (ASCP), CIC, director of infection control at St. Marys Healthcare System for Children, and Heather Painter, RN, St. Marys palliative care program manager.