Forum topic

 There are at least 3 clinical studies reporting good outcomes with the disinfectant protective caps. I am not aware of any studies on the scrubbing device yet. Lynn

We use both products because they serve different purposes.  The Site Scrub takes the place of an alcohol wipe for cleansing hubs.  It eliminates the risk of touching the hub with your fingers which often happens when using an alcohol wipe.  The Swab Cap or Curos cap is placed on the hub after use to continuously bathe the hub in alcohol until the next use.  So I think both are beneficial.  There is some question about the disinfectant alcohol caps being "passive" disinfection rather than "scrub the hub" active disinfection which the CDC recommends - some hospitals are scrubbing the hub after removal of the alcohol cap.  To me, this negates the use of the disinfectant cap and just adds expense.  Since hub manipulation is a major cause of CLABSI, I think the caps and Site Scrubs are both beneficial products.

 CDC Guidelines were written and released in 2011, before there were any studies on the disinfectant caps, therefore they did not consider them at all when writing their recent guidelines. So I would not consider the CDC statements to be in conflict or opposition to the disinfectant caps. The more recent SHEA Compendium update recommends use of the disinfectant caps. Lynn

I feel these are 2 totally different products.  We use the site scrub to clean the lumens after blood draws (this prevents blood from "hanging out" in the threading piece of the needleless connector once it is added) and before adding new needleless connectors with central line dressing changes and the curos or swab cap is left on the needleless connector between infusions.  Just my thoughts.  Valorie

I also believe these are two separate types of products. We are a large home care/home infusion company. We have been using site scrub with our weekly injection cap changes on our central lines for several years. I am currently working on a proposal to trial Curos on our peds patients to decrease BSIs. The research is very promising with the Curos product. The only concern I have is the choking issue.

Karen Charnigo, MSN, RN, CRNI

I like the disinfectant cap theoretically. I work in the outpatient oncology setting. When a line comes to me with a curos cap on it, I feel like the needleless connector is being protected more than if it was left "naked." However, to then remove the cap and immediately connect another device (e.g., infusion, syringe), you are assuming the cap was used properly, not removed and reapplied, not dry was it was applied, etc. I don't like any practice where I have to assume that the person before did everything correctly. As a personal practice, I still remove the Curos cap and swab the hub for 15 seconds with an alcohol swab prior to connecting anything. I do not like the idea of thinking of these devices as pre-swabs, or continuous swabs because there are too many assumptions being made about the care delivered prior to my assumption of care. Am I overthinking this? I feel like other people don't worry about this as much.

Keith, I totally agree with you.  I have worked in home infusion for over 25 years and believe me, anything and everything can happen to a CVAD and the care of it, especially with patients/caregivers caring for the line.  We have been using SiteScrub for many years to clean the hub lumen of the CVAD with our bi-weekly or weekly needleless connector change.  The nurses LOVE it and call it their bottle brush.  About 6 months ago we went to the Curos cap.  We still teach our patients/caregivers to scrub the needleless connector EVERY time it is accessed, including with the removal of the Curos cap.  Because as you stated you do not want to assume that the person did everything correctly.  We had a patient one time to save money boil the Curos cap and reuse it....anything and everything can happen!  Our teaching materials and patient laminated tray with drawn step by step procedure for IV medication administration states to only use the Curos cap once but people do strange things at times with good intention.  So, I do believe that best practice at least in the uncontrolled world of home infusion should be if using Curos cap to still teach to scrub the needleless connector with removal of Curos and everytime CVAD line is accessed.  Carole