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         Clinical intelligence for supply chain leadership



July 2010

  2010 Infection Prevention Buyer's Guide

CRBSI challenge

Sometimes the simplest-looking products can be ingeniously smart. Take, for example, a recent development from start-up company Catheter 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 infections (CRBSIs).

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 CRBSI.

"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 related.

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 isopropyl alcohol.

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 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.

Catheter Connections’ DualCap
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 CRSBIs."


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