Use of disinfection cap is associated with fewer bloodstream infections, study finds

The study, which involved all four hospitals in the NorthShore system, was published in the January 2013 issue of the American Journal of Infection Control.

Because of the study results, use of the disinfection cap has been adopted as a standard of practice at NorthShore for all central IV catheters.

"Most hospitals have a hard time assuring proper disinfection of IV needleless connectors," said Marc-Oliver Wright MT (ASCP), MS, CIC, the study's lead author and Corporate Director of Infection Control for NorthShore. "This is a real concern because contaminated connectors are a major source of central line associated bloodstream infections, or CLABSIs. We found that a disinfection cap was a very effective solution to the widely recognized shortcomings of the standard method for disinfecting IV connectors."

Researchers also assessed the cost-effectiveness of the cap and concluded that its use resulted in net cost savings.

The study was undertaken because the standard protocol for manually disinfecting connector hubs, called "scrub the hub," often fails because time-pressed nurses are not always able to properly scrub IV connectors with alcohol.

CLABSIs are a serious and often fatal form of infection that many hospitals have found difficult to control. The "scrub the hub" method of manual disinfection, with its inherent challenges, is often cited as a potential cause when a hospital's CLABSI rate is high.

The study was designed to determine whether a disinfection cap overcame problems with manual disinfection. The cap (SwabCap; Excelsior Medical, Neptune, NJ) is a plastic device that twists onto the threads of the IV connector. Attaching it to the connector compresses a medical-grade foam pad inside the cap that releases isopropyl alcohol (IPA) onto the connector hub to disinfect it.

The cap is left in place between IV line accesses, and its retention seal keeps the connector bathed in alcohol while protecting it from contamination by external sources. An IV connector is a device that connects an IV catheter to tubing and helps deliver medications and nutrition. Incomplete disinfection of a connector can allow bacteria to enter the connector's fluid pathway and cause an infection.

"Disinfection caps were invented because of the problems with 'scrub the hub,'" Wright said. "Theoretically, they should compensate for those problems and provide additional protection for patients, as well. But you never know if something will work as intended until you do the research. Our study design showed in multiple ways that the cap was associated with fewer infections."