Tag: Mayo Clinic

Study ID’s Potent IV Weapon To Prevent Bloodstream Infections

Posted on by Greg Dennis

When one or two hospitals get good results with a new method for preventing infections, it’s “interesting.” When 12 do, it’s time to call the method “important.”

Which is the conclusion Gregory Schears, M.D. of Rochester, Minn. reached about his study of 12 diverse hospitals that trialed SwabCap®, a disinfection cap that is used to passively disinfect the top and threads of needleless IV connectors. Excelsior Medical, SwabCap’s maker, is a Dowling & Dennis client.

Speaking at the annual meeting of the Association for Vascular Access (AVA) – and in a follow-up clinical webinar Dr. Schears said that a disinfection cap should be considered as part of best practice protocols for eliminating central line-associated bloodstream infections (CLABSIs), which kill some 30,000 U.S. patients a year according to the CDC.

You can see Dr. Schears talking about the study here: disinfection cap video. There’s also a free webinar by Dr. Schears that provides more detail on his research, available under “Videos,” here.

How did Dr. Schears reach his conclusions?

Traditionally, nurses disinfect a needleless IV connector manually before accessing the catheter line to draw blood or administer medications or nutrition. The usual method involves scrubbing the connector with an alcohol wipe for 15 seconds, then waiting another 30 seconds for the alcohol to dry before entering the line.

Because the method has several steps, takes at least 45 seconds to do correctly, and often must be done many times a day, busy nurses often cut short the time or skip it entirely. Compliance with 45-second “scrub the hub” protocol is also almost impossible to monitor: What hospital can afford to have someone trail every nurse as she goes about her rounds?

The potential for slip-ups with this method is widely believed to be an obstacle to reaching zero CLABSIs.

The SwabCap disinfection cap, which dispenses alcohol when it is pushed and twisted onto the connectors’ threads, addresses the problems with manual disinfection. It goes on in a few seconds. It twists on just one way, like a lid on a jar, which eliminates variance. Its bright orange color handles the compliance issue, because when it is observed in place, compliance is verified.

It also does two things manual disinfection cannot. Because it creates a seal at the base of the threads, the connector top and threads are continually bathed in alcohol between line accesses. Also, prolonged contact with alcohol is proven to improve disinfection. Moreover, when the cap is in place, it is protecting against touch and airborne contamination.

The hospitals that trialed the disinfection cap in Dr. Schears’ study wanted to test whether it could produce lower CLABSI rates than with manual disinfection alone. The cap’s effectiveness was measured by comparing CLABSI data from the eight-month span prior to the cap’s implementation to the eight months following implementation. This retrospective overview encompassed some 92,000 catheter days – a large number for this kind of study.

The cap made a remarkable difference. The average CLABSI rate reduction at the twelve institutions was 61.6%, which is statistically significant (p<0.0020). The hospitals in the study covered the gamut, from medical to surgical to intensive care in both community hospitals and tertiary care facilities.

For years, a nationwide public-private effort has focused on diminishing CLABSIs, but progress has been spotty. The Schears study suggests that a far greater impact might be achieved if more hospitals adopted disinfection caps. Everything we’ve seen about this device – and the study is just the latest in a constant flow of strong results – points in the same direction.

You can see Dr. Schears talking about the study here: disinfection cap video.

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IV Needleless Connectors and Infection Risk

Posted on by Greg Dennis

It’s an inevitable part of medicine that changes in technology have unintended consequences — and that not all of them are favorable consequences.

One example is the implementation of needleless connectors for IV catheters. Designed to protect healthcare workers against accidental needlesticks, these IV connectors are used hundreds of millions of times in the US every year.

However, the same connectors are also proving to be a source of potentially dangerous central line associated bloodstream infections (CLABSIs).

Gregory Schears, M.D., a widely published critical care specialist and the physician liaison to the PICC team at the Mayo Clinic in Rochester, Minn., spoke on this topic at a meeting earlier this summer sponsored by the Joint Commission.

The prestigious and influential Joint Commission, which is the primary accreditor of healthcare facilities in the US, built its annual conference around the theme of “Come Together: A Gathering of Leading Ideas in Quality and Safety.” Dr. Schears’ talk was titled “Needleless Connectors: Where Did We Go Wrong and How Do We Make It Right?”

He began his talk by tracing the history of needles and needle-safety technology in medicine. While needleless IV connectors are very effective at protecting healthcare workers, he said, they introduce new levels of risk to patients.

“We have gone into a series of unintended consequences where what was right for the healthcare worker now may be harmful to the patient,” he said. Safety technology has largely solved the problem of accidental needlesticks during the delivery of infusion therapy, but he added: “Our responses with needleless connectors have jeopardized patient care because of the increasing risk of infection.”

How to solve this dilemma?

Dr. Schears and others are investigating the possibility that passive technologies — such as an inexpensive, twist-on disinfection cap to protect and disinfect needleless connectors between line accesses — might be part of the solution.

“We probably need to look to passive technologies such as this to help us out,” he said. His research is exploring “the question of what we can do, to help reduce colonization and subsequent infections that are associated with needleless connectors.”

Dr. Schears will be speaking about his research, at the upcoming annual conference of the Association for Vascular Access in early October. He describes his research in a brief video on disinfection caps, which you can view as part of this blog.