Good morning
I wonder if anyone can share their experience with SwabCap, especially those in the outpatient areas. Do you put a swabcap at the end of the needleless connector when discharging patient home, and how do you ensure the swabcap will be changed when it reaches its maximum lifetime? Our organization is moving toward it for inpatients, but still struggling with it for the outpatient. Part of the reason is because the homecare agency does not carry this product. Any advice will be appreciate it. Thank you - Diana
Isn't its max lifetime 7 days? What is the longest interval for patients returing to your clinic? Some oncology patients could be 3-4 weeks I guess. So I can see you dilemma. Could you teach the patients/family how to change it? Who is flushing the line periodically during these idle weeks?
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
Yes, the maximum lifetime is 7 days. Many of our oncology patients are on 2 to 4 weeks schedule, in which homecare nurse usually do the weekly flushing of the catheter. Homecare doesn't carry or supply the SwabCap, and we don't provide homecare supplies.
Then your choices are to have the disinfection cap disgarded after the first time it is removed or after 7 days, whichever comes first. And not have it replaced. So the NC connection surface would be exposed. Or your company could supply these caps. I don't see any other options.
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
I work in an outpatient clinic and we place PICCs for patient's who will be utilizing home health services. We ALWAYS educate our patients regarding the swab cab that this is a "convenience cap" for the nurse and this cap is not mandatory, and is a "one time use" product. We educate the patient and/or family what is mandatory is scrubbing the hub prior to using the line. We also educate all of our patients (in-patient and out -patient) that even though there is a swab cap present any time anyone is accessing their line the clinician should be scrubbing the hub.
Jessica Newsom
I think this is misleading your patients and may cause this to distruct the hospital where the disinfection cap is being used. Differences in products and practices has long been an issue for transfering patienrs to any other type of setting but I don't think we should be throwing one under the bus by saying these caps are only for nursing convenience. That is simply not correct as there is much more evidence supporting reduced BSI rates with these caps than with manual disinfection.
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
We call the caps "conveniance caps" because when patients go home and realize they don't have a swab cap on their line they call our outpatient office in a panic becuase their line "doesn't have a cap." It is an easy way to communicate the difference between the connector cap which must be in place and the swab cap (which has convenience qualities).
We never aim to throw anyone under the bus, it is all about patient safety. INS standards state you must still scrub the hub when the passive disinfection caps are in place, we have made it our goal to practice the standards. The problem with these caps is you must place it on a clean hub. The instructions for the swab cap state if the hub is heavily soiled you must dissinfect with alcohol prior to placing the swab cap. If you are not the one who placed the cap can you gaurentee the hub was not heavily soiled, the cap was placed appropriately, and the hub is clean and ready to use? What about the person who is unaware that these caps are a one time use and replaces the used cap? The next nurse uses the line without scrubbing the hub because a swab cap was in place.
I do beleive the caps can be effective in reducing BSI, however, I do question the fact that they are more effective than maual dissinfection. My question would be when manual dissinfection was performed was it done correctly or was it done with a quick swipe across the hub? If someone wasn't scrubbing the hub appropriately than this would explain the higher effeciacy rates with the swab cap. I would love to read the study you have referenced because I want to make sure I am keeping up with the research and evidence based practice so I can adjust my practice accordingly.
I just wanted to point out that because a swab cap isn't available doesn't mean appropriate disinfection can't be accomplished. I feel that regardless of what kind of disinfection method is used it is imperative to educate the patient/family so they can act as an advocate and ensure things are being done appropriately. You would be surprised with some of the horror stories we hear from our outpatient population regarding the care and maintenance of their central lines.
Jessica
Jessica Newsom
I would still not refer to these as a convenience as that is not correct. YOu are preaching to the choir about following INS SOP because I wrote the very language you are quoting, however it says scrubbing is necessary for SUBSEQUENT connections or those that follow after the disinfection cap is removed and the first saline syringe is attached. Here is the major reference showing disinfection caps to have better outcomes than manual disinfection - 3 phases, one with manual scrubbing, one with disinfection cap, then third phase with manual scrubbing, multiple hospitals. 1.Wright MO, Tropp J, Schora DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control. 2012;41(1):33-38.
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
adding to Jessica's comments, vendors spend a great deal of time and money educating then monitoring compliance in facilities that use these caps. I would suggest the investment in "scrub the hub" education impacts the reduction in BSI significantly and then monitoring compliance on a regular basis helps maintain the results.