New IV Catheter Disinfection Protocol to Be Featured at Patient Safety Meeting

A hospital’s evaluation trial of the SwabCap™ disinfection cap for needleless IV connectors showed the cap achieved compliance with a new Joint Commission requirement, according to a poster to be presented at the National Patient Safety Foundation Annual Congress. The poster noted, “Many needleless connectors have hard-to-reach surfaces that make them difficult to properly disinfect, even if nurses wipe for the full 15 seconds and then wait for drying as experts advise.”

In addition to demonstrating successful compliance, the hospital’s infection control department also assessed the financial impact of using the catheter disinfection cap for cleaning needleless connectors (also known as injection ports). The assessment weighed the kit’s cost, saved nursing time, and materials eliminated for swabbing/flushing. The analysis found an annual savings of $25,000.

The Joint Commission now requires that applicant healthcare facilities have in place “a standardized protocol to disinfect catheter hubs and injection ports before accessing the ports.”

Like many other institutions, the urban hospital discussed in the poster had adopted a disinfection protocol widely recommended by experts. The older protocol for wiping needless connectors/injection ports with alcohol takes a minimum of 45 seconds.

The hospital, based in a large northeastern U.S. city, worried that because its nurses were often pressed for time, it was unrealistic to expect them to expend the full 45 seconds. Moreover, there was no way to confirm that nurses had complied without following them during their duties, which was also unrealistic.

Implementing SwabCap from Excelsior Medical addressed both problems. The disinfection cap takes only a few seconds to apply, and its design disinfects the recessed openings of needleless connectors. The cap’s bright orange color makes it easy for supervisors to confirm compliance. When attached to a connector, the cap also provides a physical barrier against touch and airborne contamination.

“Many needleless connectors have hard-to-reach surfaces that make them difficult to properly disinfect, even if nurses wipe for the full 15 seconds and then wait for drying as experts advise,” said Nancy Moureau, RN, BSN, CRNI, CPUI, author of the presentation and founder of PICC Excellence, a training, educational and consulting company. “Nurses could comply perfectly with the wiping policy and patients might still be at risk of a dangerous infection. The device does a better job of disinfecting, while also protecting against other forms of contamination. At the same time, the cap can reduce overall costs while solving the compliance challenge of the Joint Commission requirement. We found this to be an unusually beneficial combination for patient safety.”

The poster described a trial of Excelsior’s SwabKIT™ in 40 beds in the hospital’s NICU, coronary care unit, and step-down unit. SwabKIT combines SwabCap with a 10 mL ZR™ pre-filled saline flush syringe. During the trial, compliance with the hospital’s disinfection policy was 100%, as measured by visual confirmation of the cap’s use with each patient.

The 18 nurses who participated in the trial completed a questionnaire about their experience using the kit. Every nurse gave positive responses to all items on the questionnaire. Among their responses, nurses agreed that the kit “eliminated unnecessary steps,” did a more thorough job of disinfection than alcohol swabbing alone, and improved compliance with infection prevention practices. All 18 nurses supported the hospital’s continued use of the cap.

The hospital involved in the study preferred anonymity during its safety initiative but allowed presentation of the results.

SwabCap is used to disinfect swabable luer access valves. The device contains 70 percent isopropyl alcohol and twists directly onto the valve, passively disinfecting the valve top and threads. The device protects patients by disinfecting the needleless connector after 5 minutes of application. The cap provides up to 96 hours of protection under normal conditions if not removed.

ZR Syringes use anti-reflux technology designed to minimize syringe-generated reflux, which is one of the causes of catheter occlusions, a complication of long-term catheter use. Both products are terminally sterilized for increased patient safety.

Robert B. Dawson, MSA, BSN, RN, CRNI, CPUI, was the co-author of the poster and will present the findings at the meeting of the National Patient Safety Foundation, May 18-19 in Orlando, Fla.