The use of disinfection caps is included in major new infection-control recommendations sponsored by the Society for Healthcare Epidemiology of America (SHEA) and other top infection-control organizations.
The practice recommendations mark the first time that disinfection caps have been included in a leading set of guidelines for hospitals. It is also the first time that the benefits of using disinfection caps have achieved this degree of recognition from a panel of the nation's leading infection-control experts.
Disinfection caps cover, protect and disinfect IV needleless connectors, which are also known as hubs, ports or valves.
The recommendations, just published in the journal Infection Control and Hospital Epidemiology (ICHE), include the use of "an antiseptic-containing hub/connector cap/port protector to cover connectors" when a hospital has an unacceptable rate of central line-associated bloodstream infections (CLABSIs) after implementing basic prevention strategies.
The SHEA authors placed the quality of evidence to support the use of disinfection caps in Category I, which is the highest ranking possible in the document.
"As hospitals strive to improve patient safety, the new guidelines about disinfection caps apply to a significant number of hospitals in the U.S.," said Excelsior Medical President and CEO Steve Thornton. "We are very pleased that these influential infection-control organizations have recognized the quality of the research supporting disinfection caps, and the role they can play in substantially improving patient safety."
Among the studies cited in the new SHEA document is one from the Chicago-area NorthShore University HealthSystem. The study documented the hospital system's success using the SwabCap disinfection cap and was published in the American Journal of Infection Control (AJIC).
"The SHEA recommendations are always highly influential, and the inclusion of disinfection caps can be expected to increase the use of these caps," said Marc-Oliver Wright MT (ASCP), MS, CIC, lead author of the AJIC study and Corporate Director of Infection Control for NorthShore. "Most hospitals have a hard time assuring proper disinfection of IV needleless connectors. We found that a disinfection cap is a very effective solution to the widely recognized shortcomings of the standard method for disinfecting IV connectors."
The standard "scrub the hub" method traditionally used to disinfect IV needleless connectors is also included in the SHEA document, though the paper raises a question about the length of time required to scrub.
The recommendations also encourage hospitals to "monitor compliance with hub/connector/port disinfection, since approximately half of such catheter components are colonized under conditions of standard practice."
Monitoring compliance is facilitated by the highly visible orange color of the SwabCap disinfection cap. When clinicians see the cap in place on the connector, compliance with disinfection is visually confirmed.
SwabCap comes in sterile packaging and so can be placed upon the valve aseptically. It is the only disinfection cap with a 510(k)-cleared claim that it maintains a disinfected valve surface for up to seven days if not removed.
In addition to using disinfection caps with central venous catheters, a growing number of hospitals also apply disinfection caps on needleless connectors for peripheral IV lines. The SHEA document notes that other kinds of catheters such as peripheral IVs are "associated with risk of bloodstream infection" and adds, "Future surveillance systems may need to include bloodstream infections associated with these types of catheters."
The new recommendations, published in the July 2014 issue of ICHE, are an update to guidelines published in 2008. The 2008 document was published before disinfection caps were generally available and before any clinical studies could be done with them.
The recommendations are a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission. Representatives of various infection-control organizations also contributed to the recommendations. The full document is available here.