Study Shows Promise of Disinfection Cap as Weapon in the War on Infections

For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.

That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.

Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.

NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.

The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at

IV Connectors: Younger Nurses May Be More Diligent Cleaners

We often think of young people as rebels and their elders as better at following rules. But the opposite is true in American hospitals, a new study says – at least when it comes to disinfecting IV connectors.

Recent graduates of nursing school were more likely “to consistently use optimal disinfection techniques” than were more experienced nurses, according the study, in the May-June issue of the Journal of Infusion Nursing,.

The research examined whether younger or more experienced nurses adhered more closely to the “scrub-the-hub” manual method for disinfecting connectors. The method requires nurses to scrub the connector hubs with alcohol for up to 10-15 seconds and then wait up an additional 30 seconds for the alcohol to dry before accessing the line.

This protocol is widely recommended by infection control experts, but it must be performed meticulously to have any chance of being effective. The method’s several steps mean that variation is common, and busy nurses are known to sometimes skip disinfection altogether. The consequences of variation or noncompliance are great because incomplete disinfection increases the risk for sometimes deadly central line-associated bloodstream infections (CLABSIs).

The study found that nurses just out of school were more likely to perform the protocol exactly as it was taught – a good thing. The more experienced nurses, conversely, rated higher than younger nurses in such qualities as autonomy and “self-efficacy” (essentially, belief in one’s own competence). One can assume from this that more experienced nurses felt more free to stray from the protocol – not a great idea in this case and one that put patients in danger.

The findings may point toward one reason hospitals should be using a disinfection cap such as SwabCap® to supplement manual disinfection. SwabCap, from our client Excelsior Medical, is ingeniously designed to eliminate variation and noncompliance.

By prolonging the hub’s contact with alcohol, it may also increase the bacteria kill over manual methods, especially when compliance with the manual method is not optimal.

Considering what’s at stake, it seems to us that using the cap is a no-brainer – even if a nurse just graduated magna cum laude.

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Vascular Access Group on LinkedIn

LinkedIn is a tremendous information resource for professionals. But for the most part those in nursing – especially professionals with an interest in infusion therapy and vascular access – have been underrepresented on LinkedIn.

No more! We’ve just established a new forum for vascular access professionals on LinkedIn. It’s open to anyone interested in the field, who wants to read or post about issues and questions pertaining to vascular access.

We hope you’ll consider joining the group. To do so, go to Join LinkedIn if you are not already a member, then search the “Groups” function for the phrase “vascular access.”

Thanks, and we hope to see you over on LinkedIn soon.

CMS Gets Tough on Infection Reporting

Ushering in the new year in its own way, the Centers for Medicare and Medicaid Services (CMS) has dropped a hammer on hospitals. A new rule requiring hospitals to report certain central line-associated bloodstream infections (CLABSIs) went into effect last month.

Specifically, the rule states that hospitals must now report the number and rate of adult patients in their intensive care units who get CLABSIs — or the hospitals’ Medicare payments will be reduced by two percent.

We first wrote about this rule in our October 27, 2010 post and you can read the rule’s details there. Part of the rule requires the infection data to be publicly reported on the government’s website, That part of the rule will go into effect later this year.

At Dowling & Dennis, we applaud CMS’ report-or-pay approach. In fact, we think they should carry it a little farther. For instance, the rule only concerns patients in ICUs. We think it should apply hospitalwide.

Even at this point, though, we think this national incentive will be a useful supplement to the patchwork of state reporting laws. There are 27 states that make infection reporting mandatory, with two more that require confidential reporting, and three that have voluntary reporting systems. We expect that the CMS rule will push most hospitals across the country to divulge their infection data.

After all, two percent of Medicare payments is real money.

We’ve learned how important the CLABSI issue is because several of our current or former clients — including Excelsior Medical (SwabCap), Johnson & Johnson (Biopatch), RyMed Technologies (InVision-Plus), and Venetec International (StatLock) – produce medical devices shown to reduce CLABSI risk. Much of our effort the past several years has been to promote the use of these safer technologies.

Where these devices have been implemented, CLABSIs have generally gone down – dramatically. CLABSIs still kill 31,000 U.S. patients per year – in part, because hospitals aren’t adopting such devices fast enough, as many infection control experts have testified.

The CMS rule has several things going for it. For one thing, the data that hospitals report to HospitalCompare will be based on objective, CDC-defined criteria. That isn’t always the case with some state reporting requirements, so that when a consumer compares Hospital A’s infection rate to Hospital B’s, they’re actually comparing apples to oranges. The CMS rule should get us close to apples-to-apples comparisons.

Also, many consumers who have to be hospitalized are likely to go to HospitalCompare to find the safest facilities. You would think all institutions will want a presence in that online system – a presence that includes a low CLABSI rate. This is CMS’s hope, and ours.

Contaminated Alcohol Swabs: One More Reason to Use Disinfection Cap

There were already real concerns about the use of alcohol swabs to disinfect needleless IV connectors. Now here comes another one: The pads themselves can be a source of potentially deadly contamination.

The FDA announced Jan. 5 that Triad Group, a Hartland, Wis. manufacturer, was voluntarily recalling all lots of its alcohol prep pads, alcohol swabs, and alcohol swab sticks because they might be contaminated with the organism Bacillus cereus. Use of any of these products, if contaminated, “could lead to life-threatening infections, especially in at-risk populations, including immune-suppressed and surgical patients,” the FDA’s press release said.

Triad products are widely used in the healthcare marketplace, not just under the Triad name but also as private-labeled products for corporate customers. In addition, various companies include them in their medical product packages – which is why corporations such as Bayer and Genentech are informing their customers about the recall and warning them not to use the Triad alcohol products packaged with their medicines.

Even before this brouhaha, many infection control professionals worried about the use of alcohol swabs to disinfect IV connectors. Hospitals generally require that connectors be disinfected before a clinician accesses an IV line for a blood draw or to inject nutrients or medication. The traditional method involves scrubbing the port with an alcohol swab for 10-15 seconds and then waiting for the alcohol to dry before accessing the line.

Even if the swabs are sterile, this somewhat complicated, time-consuming method is prone to variance and noncompliance, which increases the chances of a potentially fatal bloodstream infection.

“Alcohol prep pads are only as good as the person using them. Prep pads are rarely used long enough or with enough friction to cover all surface areas,” says Nancy Moureau, vascular access specialist with PICC Excellence (Hartwell, Ga.)

The best way to avoid the pitfalls of alcohol scrubbing – not to mention contaminated swabs – is to use a disinfection cap such as SwabCap (Excelsior Medical, a client of Dowling & Dennis). SwabCap twists onto the threads of the connector. Its patent-pending design keeps the entire port bathed in alcohol, an ideal disinfection scenario.

Because it is left on between line accesses, it also protects against contamination of the port during that time, something that even meticulous scrubbing can’t do. Variation in technique – a recognized source of infection risk with alcohol pads — is virtually impossible, because the cap twists on one way, like a nut onto a bolt. Compliance is simple to verify. If the bright orange cap is attached to the port, compliance has occurred. No wonder we’ve seen bloodstream infection rates plummet at one hospital after another when they adopt the device.

Hospitals that use alcohol swabs to scrub connectors are busy emptying their shelves of Triad alcohol products if they stocked them. But they still have to fret about variation in technique, noncompliance with the alcohol-pad protocol, and contamination between line accesses.

Hospitals that use disinfection caps like SwabCap, by comparison, know they have an extra measure of protection and disinfection.

Patient Safety Gets a Certification Program — At Last

More than a decade after patient safety hit the national agenda with the publication of the Institute of Medicine’s “To Err Is Human” report, someone is finally putting together a certification program for professionals involved in ensuring patient safety.

The leading group in this field, the National Patient Safety Foundation (NPSF), has just launched the certification program. It’s designed to standardize a curriculum, elevate the profession and share best practices.

“Patient safety is a top priority for our healthcare system,” said Dr. Lucian L. Leape, chair of the Lucian Leape Institute at NPSF. “But we will not be able to truly move the needle until those who are involved in the practice have the knowledge base necessary to do the job. The certification program is an essential element in that quest.”

Dr. David Shulkin attempted as far back as the late 1990s to highlight the profession through creation of the Patient Safety Officers Society. PSOS got some early traction but hasn’t been active for several years. Dr. Shulkin is now president of Morristown (N.J.) Memorial Hospital and vice president of its parent, Atlantic Health.

This time around, NPSF reports, membership in the American Society of Professionals in Patient Safety is open to professionals whose primary responsibility is patient safety as well as others across the healthcare disciplines.

Our view: The patient safety field represents the essential nexus of numerous healthcare fields, and NPSF’s new initiative represents a major step forward in better protecting patients. More details at


New CMS Rule on Infection Reporting

If hospitals see more revenue from the Centers for Medicare and Medicaid Services (CMS) next year, they may owe a thank-you to the Society for Healthcare Epidemiology of America (SHEA) – and their own infection prevention pros.

SHEA is urging infection control professionals to get up to speed on new CMS requirements for reporting central line-associated bloodstream infections (CLABSIs). Starting in 2011, CLABSIs and certain other healthcare-acquired infections (HAIs) will have to be reported on the CDC’s National Healthcare Safety Network (NHSN) for hospitals participating in the CMS Hospital Inpatient Quality Reporting Program. Participation in the programs is voluntary but here’s the catch: Hospitals can’t get full CMS payment without taking part.

How does the process work? Hospitals report their CLABSI data from their adult and pediatric intensive care units and neonatal intensive care units to NHSN, which then shares it with CMS.

Each facility’s data will be also be uploaded to CMS’s Hospital Compare tool, which is designed to publicly report hospital performance so it can be usefully compared.

The focus on CLABSI data will benefit patients will also live in the value of industry’s contributions to preventing infections. Included in the latter, among companies with which we work, are Excelsior Medical and RyMed.

The partnership between CMS and NHSN is intended to create greater transparency of HAI data, make hospitals more accountable for quality care, and boost facility’s support for infection prevention programs and professionals. Read more about NHSN here: .

IV Journal Launches, on the Cutting Edge

Here’s further evidence that vascular access and infection control remain cutting-edge efforts in medicine.

At a time that is witnessing the death of many publications, including several in the healthcare trade media, a new publication covering intravenous care has been launched. Rather than tie itself down to the old paper-publication model, the new IV Journal is online only.

But happily, publisher Andrew Jackson, out of Britain, has created a journal that uses the best of online technology and is also visually appealing. News of the launch can be found here: He’s also drawing on contributors internationally.

Here’s how Jackson describes IV Journal:

“This intrepid, innovative new publication acknowledges the rapidly changing nature of intravenous care. Traditional paper based publications are usually bound by subscription restrictions. Intravenous Journal wants to provide a subscription-free online format to provide any IV professional with a unique IV journal experience.”

It’s also worth noting that Jackson publishes the very useful electronic newsletter, IV Team. More about that at

AVA Conference Highlights CRBSI

We’ve recently returned from the very successful annual meeting of the Association for Vascular Access ( Though many hospitals have reduced the size of their IV teams or eliminated them altogether, it was obvious from last week’s gathering at the gigantic Gaylord conference center in National Harbor, Md. that there is still a substantial cohort of vascular access experts out there, working hard and deeply committed to better patient care.

One of the highlights of the conference for us was doing a focus group with Excelsior Medical, makers of the SwabCap disinfection cap for needleless IV connectors. Excelsior took the time and effort to meet with a small group of nurses to get some qualitative, very informative feedback about the vascular access challenges that nurses face.

Earlier in the month, Excelsior also teamed with AVA to cosponsor a webinar on best methods to disinfect needless connectors. The webinar is archived at

The focus group and other feedback indicate that hospitals and vascular access nurses remain open to new and better means to achieve two goals:

1.) Complying with Joint Commission and similar protocols for cleaning needleless connectors/disinfection caps.

2.) Reducing catheter-related bloodstream infections (CRBSI, also known as a central line associated bloodstream infections or CLABSI).

Watch this space for more about the AVA conference and other new technological developments featured at the conference.

Get Infected, Stay in the Hospital

A new report on healthcare-acquired infections (HAI’s) tallies up their financial and mortality toll. The report confirms what’s already been known – patients who get an infection while in the hospital have to stay in hospital longer – and also reveals it’s worse than many of us thought.

Turns out that adults who get an HAI while in the hospital had to stay in the hospital an average of 19 days longer than those who didn’t get an infection, according to the Agency for Healthcare Research and Quality.

Moreover, the report on 2007 data shows those adults are six times more likely to die while in the hospital. Not surprisingly, costs associated with an HAI were $43,000 higher per patient.

Amid these grim numbers there was a bit of good news: AHRQ reported a decline in the rate of infections among medical and surgical discharges after a peak in 2004 and 2005.

More on this from Infection Control Today magazine at, and from AHRQ’s new statistical brief, “Adult Hospital Stays with Infection Due to Medical Care, 2007” PDF at