Port protectors and scrub the hub

[varc]

Our hospital has just switched to the SwabCap for port disinfecting. We were previously using the Site Scrub by Bard to scrub the hub prior to accessing the port and also before changing the end caps. The SwabCap is supposed to be applied to each needleless connector on the IV tubing and each central line/PICC port that is not in use.

The package instructions state "SwabCap will disinfect the valve 5 minutes after application and maintains a disinfected valve surface for up to 7 days if not removed". "Valve is ready for use. No further swabbing is necessary".

I may be paranoid but I don't trust not scrubbing the hub again before access. I like the idea that the cap protects the port from contamination between use but I don't trust that the cap has been in place the entire time or at least 5 minutes. I feel better if I scrub the hub in addition to the cap then I'm double protected against infection.

My hospital did away with the Site Scrub so I would have to use an alcohol wipe to clean before access. After MUCH discussion, I was asked to reach out and see if any of you felt as I do. Do any of your institutions use both procedures at the same time (port protectors PLUS scrub the hub before access)?

[melizerd, ASN, RN]

I've used both depending on the facility. I don't have a problem with either, there's science behind both options.

If it makes you feel better replace the cap, wait 5 min then use it. Though I'm going to bet long term this isn't a great solution because it's a waste of resources. It will just take time for you to be comfortable with the change.

[RN403, BSN, RN]

I feel that swab caps are effective enough. If I have any doubt about the length of time that the cap has been in place I just pull out an alcohol wipe. I think there is enough evidence at this time that supports their use and effectiveness. If you feel more comfortable using an alcohol wipe in addition to the swab caps then go ahead and utilize it. It couldn't hurt.

[firstinfamily, RN]

We do both at our facility, I haven't looked at the stats yet to see if the infection rate of lines has decreased.

[inchii]

We use a different brand in our hospital - Curos caps. It is advertised to disinfect in 3 minutes. We don't scrub the hubs anymore unless it is obviously soiled or if it has only been 3 mins. So far it works well in our hospital and no central line related infection in our unit.

[blondy2061h, MSN, RN]

Our policy does not permit further scrubbing of the hub after the Curos is removed. They're concerned that messed with the alcohol wipe will give more of a chance for it to become dirty or it to rub against the linens or something.

The only exception is if it's been under 3 minutes, or if it got wet (they need to be replaced after a patient showers).

[iluvivt, BSN, RN]

You can trust what both Curos and Swabcap tell you for each product as long as you follow their IFUs. They are super saturated. Pick one out and you will see. When you take the port protector off just make sure whatever connection you are entering the system at has NOT come in contact with linen, the pt's skin or other fomites or you will need to perform another 10 to 15 sec alcohol scrub. I often take a 2 x 2 or alcohol pad and slide it under any hub that is flush with the skin before I take the Curos off to use that injection port. The beauty of Bards site scrub is that you can use them on any CVC hub after you remove a needleless connector (NC) and are changing it to another. The site scrub is a great no touch way to get any IV connection clean.To bad they got rid of site scrub because when you need to clean any hub this is a great no touch product. The are super cheap too! You will find some are not as diligent in keeping their port protectors in place. I order site scrub for our team since it is the only product I like for cap changes. Years ago I read that an IV expert used to dip sterile Q tips in hydrogen peroxide and clean the connection after removing an NC and putting a new one on. Long term lines are challenging and while dressing changes are important I am convinced bacteria get in fro the NCs and the NCs NIT being changed at least every 7 days. When you are forced to use an alcohol pad peel it from the top and grab it on one side and then use only the other side to scrub and use more than one if you have to or have the very small horrible ones which are really only good for (IMO) a skin scrub before an injection.

[varc]

We are going to trial that one as well

[varc]

I appreciate all of the comments. I did not mention that I am also an Infusion Nurse and responsible for educating the staff in best practices for infection prevention regarding IV/central/PICC lines. I was actually preparing to teach a class when this change came about so I am now charged with educating the staff that the SwabCap alone is what we are switching to. As I mentioned earlier, I like using them as a disinfecting port protector between use but for scrubbing the hub between needleless connector changes I prefer the SiteScrub. Also for our oupatient departmens like oncology and ambulatory surgery and even emergency department, I think the SiteScrub is a better option.

[~PedsRN~, BSN, RN]

We do not have the caps, we scrub. But some of our chronic patients with lines use the caps and are becoming increasingly worried when they see we do not. I'd love to trial these on our floor..... They just snap in the pressure blue caps?

[varc]

The caps twist into position

[VANurse2010]

If you're just going to clean the port anyway, why bother with the expense of the caps? Might as well invest those $ in other nosocomial infection prevention programs.