Greetings,
I was looking for an update on some of the discussions that were on here a while ago of the relative merits of the SwabCap versus the Curos Port Protector or other luer acces valve caps with 70%IPA. There had been some discussion questioning the value of these devices and saying that swabbing was going to be appropriate even with these devices. There was reference to upcoming clinical trials. I'm wondering if anyone has any more information?
Do you use the caps and if so what has your experiene been? Do you trust them? Are you swabbing anyway? How expensive are they? Do they work well within your facility? Is their use at your facility increasing, degreasing or staying the same?
I have no connection with either firm or their products.
Thank you.
Dave
First let me say that I am a consultant for both companies. So I will not discuss the idea of one being better than the other. That choice is made by each end user. I do firmly believe in the benefits of protection/disinfection caps because of 3 good clinical studies showing a reduction in CLABSI with the use of these caps. Given the many facts associated with manual cleaning, I believe that these caps are required.
1. Needleless connectors are a known location for biofilm growth and subsequent infection - see INS and CDC for this info.
2. Manual scrubbing will never be adequate due to many human factors and product design issues. All needleless connectors have the risk of infection. We have no knowledge from clinical studies of one connector design opposed to another. The ones with an external split septum are regarded as being the "most forgiving" of questionable technique.
3. Studies of manual scrubbing are all in vitro studies. There is one study from 2012 showing that Baxter Interlink requires 5 seconds of scrubbing time, but other studies of mechanical valves show that 15 seconds is more effective at reducing organisms that get flushed through the connector.
4. Busy nurses do not have the time to guarantee that they will scrub for 15 seconds each and every time they access a connector.
5. One new study is showing that CHG/IPA does have effectiveness on plastic for up to 24 hours - again another in vitro study culturing the effluent. Does that mean that a manual scrub with CHG/IPA is better than these caps? No studies yet on this question.
6. These connector surfaces need to be protected between uses. These caps offer the best option at the present time. We do have studies quantifying the amount of biofilm on intraluminal walls, showing that longer dwells, usually greater than 7-10 days have much larger amounts. Everything we do to the catheter hub will allow for introduction of organisms that leads to this biofilm and then to CRBSI.
There are now 3 studies - one case crossover study design, and 2 before/after studies. All 3 show distinct reduction in CLABSI with the use of these caps.
None of these companies are saying that manual scrubbing will never be required. In fact, when a nurse is giving a med using S-A-S-H, the intital saline syringe can be attached after removing the protection cap without any further scrubbing. After that there should be a scrub before each entry of the remaining 3 connections. There could easily be blood-tinged fluid drops on the connection surface after disconnecting the syringe. If a med is infusing for 30 to 60 minutes that connection will be lying in the bed and is subject to a similar level of contamination as an unprotected connector.
I see the use of these caps growing. I just returned from giving a presentation to a group of 70 critical care nurses on intraluminal causes of CRBSI and definitely included the science on these caps.
Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861