Patient Safety and Educating IV Nurses

As nurses have more demands placed on them to ensure patient safety, effective tools for educating nurses become increasingly important.

After all, how can we expect nurses to handle sophisticated technology in the most effective way, if we don’t do a good job of teaching them and involving them in the learning process?

One new tool for that educational process, when it comes to vascular access and infusion therapy, is an infographic recently presented as a scientific poster at the annual conference of the Association of Professionals in Infection Control and Epidemiology (APIC).

You can view a brief video about the infographic — which features a disinfection cap for protecting needleless IV connectors from contamination — on the PICC Excellence website of presenter Nancy Moureau, RN, BSN, CRNI, CPUI, here.

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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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.