Sometimes the simplest-looking products can be ingeniously
smart. Take, for example, a recent development from start-up company
Connections. The brainchild of two infusion nurses, the company makes a unique
and inexpensive dual capping device designed to disinfect and protect both ends
of an IV line, which could reduce the risk of catheter-related bloodstream
Vicki Farrar, chief executive officer for Catheter Connections,
underscored the serious nature of CRBSIs, which are in fact, the 8th leading
cause of death in the U.S. "There are about a half million CRBSIs in the U.S.,"
shared Farrar, adding that about half of those occur in the ICU where there are
a high number of patients with central venous catheters, a leading route of
"CRBSIs are receiving a lot of attention not only because they
are serious in terms of lives lost and cost to treat but most importantly
because so many are preventable" she remarked.
It’s commonly recognized that CRBSIs are often caused by
bacteria contaminating the connection ports or hubs of an IV administration set,
one of which is the needleless injection site. For this reason, facilities have
adopted "scrub the hub" protocols – where nurses are instructed to vigorously
scrub the connector port with isopropyl alcohol for at least 15 seconds.
However, compliance is poor, and by no means is it 100% fail-safe. Even with
meticulous scrubbing, it’s been shown that microbes often remain, Farrar
In fact, 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."
Responding to this challenge, a handful of manufacturers have
introduced caps designed to bathe or scrub the needleless injection site with
SwabCap from Excelsior Medical
A hospital’s evaluation trial of
Excelsior Medical’s SwabCap
disinfection cap for needleless IV connectors showed the cap achieved compliance
with the new Joint Commission requirement, according to a poster presented at
the National Patient Safety Foundation Annual Congress.
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. The
assessment weighed the kit’s cost, saved nursing time, and materials eliminated
for swabbing/flushing, and found an annual savings of $25,000.
The urban hospital discussed in the poster had adopted a
disinfection protocol for wiping needleless connectors/injection ports with
alcohol that 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
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
Likewise, Catheter Connections’ DualCap provides protection for
the needleless injection port, however Farrar emphasized that this is only part
of the problem.
"The connection at the end of the IV tubing – called the male
luer – has proven even more contaminated than the needleless injection site,
based on our preliminary clinical data," she said. Contamination of the male
luer can result from connecting it to a contaminated needleless injection site,
airborne microbes, the luer touching the IV pole, the bed, the patient’s skin,
or even inadvertent contamination from the nurse, she explained.
Previously overlooked as a potential route for contamination,
the male luer also presents unique challenges to alcohol disinfection, owing to
the fact that the male luer is directly connected to the IV fluid path, and if
isopropyl alcohol gets into the IV fluid path it will be transmitted into the
bloodstream, which is toxic. The standard practice of swabbing the needleless
injection site cannot be safely done for the male luer.
Taking this into account, Catheter Connections’ DualCap device
not only protects and disinfects the needleless injection sites, but also the
male luer end of the IV tubing. Featuring an intricate, patent-pending design,
DualCap seals the fluid path before bathing the male luer in alcohol providing
an added layer of protection and prevention.
"Even if the healthcare worker hasn’t scrubbed that port long
enough, the patient is now going to be more fully protected from microbes that
can cause CRBSI," said Farrar. "With the DualCap, the product becomes the
protocol, it provides a visual compliance check that the hospital quality
personnel can look at these IVs and see these light blue and dark blue caps and
know that IV connections are disinfected and protected."
Farrar commented, "Hospitals are spending a lot on hand hygiene
campaigns and scrub the hub campaigns for washing that needleless injection site
with isopropyl alcohol. Studies have shown around $75K per campaign. The DualCap
provides a cost-effective, easy-to-use solution to address two key routes of
contamination. It is a critical tool for clinicians in their fight against