Forum topic

 Mark, I am assuming that you are asking about the disinfection caps that are placed on top of needleless connectors. If so, there are now 3 clinical studies with outcomes on these devices. I am not aware of any clinical studies on manual scrubbing, only in vitro studies. Here are those studies:

1. Wright MO, Tropp J, Schora DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control. Oct 17 2012.

2. Sweet MA, Cumpston A, Briggs F, Craig M, Hamadani M. Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line–associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. American Journal of Infection Control. 2012.

3. Ramirez C, Lee AM, Welch K. Central Venous Catheter Protective Connector Caps Reduce Intraluminal Catheter-Related Infection. Journal of the Association for Vascular Access. 2012;17(4):210-213.

Lynn

We are using Curos on Carefusion tubing.  The caps seem to spin on the injection sites and don't lock down.  I worry about it not being an airtight seal and the alcohol drying out.  They are also a little difficult to get to thread.

Darilyn

We initially tried the Curos port protector.  It fit loosely on the needleless connectors.  We also found several to be dried out when we peeled to cover off.  Also, when taking the cover off, we noticed that a plastic layer remained and you had to pry that off.  We have since switched to Swab Caps and have been very happy with their performance.  They have a snug fit and no touch application.  We are much more satisfied with the Swab Cap!

 The new SHEA Compendium 2014 update, CLABSI chapter recommends disinfeciton caps. This is not specifically written for home care. I have not seen any studies of using these devices in home care yet but it only makes perfect sense to me to use them. That exposed connection surface on all connectors and injection ports would be subjected to similar environmental contamination as in the hospital. CDC and INS have not revised their documents since the studies on these devices were published but I am certain the next editions will address them. Go to my website, listed in my signature below, click on my Blog to find a recent post about this new SHEA doument with a connection to download it for free. Lynn

I manage a home infusion nursing program throughout Northern California and our Home Infusion Pharmacy (Sutter Infusion and Pharmacy Services) recently started using the Curos alcohol cap/cover.  Due to the fact that I was concerned our home infusion patients/caregivers might while unscrewing the Curos also unscrew the needleless connector and leave the extension or hub open, we went to a bonded extension with needleless connector.  We try to use these on all our PICCs.  We have only been using them for a month but our patients love them because they feel the cover/cap protects the line better.  We do still teach and practice that an alcohol wipe is still used with each access to the line along with the Curos cap.

We routinely change our bonded extension and needleless connector with every lab draw via CVAD and at least 7 days.  On our higher risk patients (on TPN, history CLBSI, some noncompliance history, peds, immune compromised, etc.) we change them 2 times a week (set up schedule of Monday, Thursday or Tuesday, Friday).  This would cover over 50% of our patients.  I would love to go to 2 times a week on all patients but there are many reasons in homecare that we can not.  This is due to the fact some patients have co-pays for visits and do not want to pay for 2 visits a week.  Also getting insurance authorization for 2 times a week is sometimes hard.  We have trained some of the caregivers to change it one time a week and nursing will change it one time a week with CVAD dressing change.  But we only train those we trust will do an aseptic technique and understands the procedure and risk of air emboli/contamination.  Our CLBSI rate is low but not zero.