Patent Publication Number: US-2023146509-A1

Title: Disinfecting cap

Description:
BACKGROUND 
     Within the medical field, and in particular the area of infusion of fluids or aspiration of fluids to or from a patient, there is a need to prevent the transmission of pathogens into or onto a patient from a potentially contaminated surface of a medical implement. Such pathogens include microorganisms such as bacteria and viruses. The transmission of pathogens into a patient may result in an infection that could be life threatening. Common sites for such transmissions are found at access “sites” of medical implements such as a luer port, vial, needle free valve, or an injection port of a vessel, tubing, or catheter. Even non-intrusive medical implements such as stethoscopes or otoscopes can transmit pathogens to a patient. 
     Accordingly, a need exists for an apparatus and technique for cleaning a site on a medical implement prior to contact with a patient. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Advantages of the invention will become apparent upon reading the following detailed description and upon reference to the drawings. 
         FIG.  1    is a perspective view of a disinfecting cap exemplary embodiment showing a closed end of the cap. 
         FIG.  2    is a perspective view of the disinfecting cap of  FIG.  1    showing an open end of the cap. 
         FIG.  3    shows a cross-sectional view of the disinfecting cap of  FIGS.  1 - 2   . 
         FIG.  4    is a perspective view of a disinfecting cap exemplary embodiment showing a closed end of the cap. 
         FIG.  5    is a perspective view of the disinfecting cap of  FIG.  4    showing an open end of the cap. 
         FIG.  6    shows a cross-sectional view of the disinfecting cap of  FIGS.  4 - 5   . 
         FIG.  7    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  8    is a side view of the disinfecting cap of  FIG.  7   . 
         FIG.  9    is a cross-sectional view of the disinfecting cap of  FIG.  8    along line A-A. 
         FIG.  10    is an end view of the disinfecting cap of  FIG.  7    showing an open end. 
         FIG.  11    is an end view of the disinfecting cap of  FIG.  7    showing a closed end. 
         FIG.  12    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  13    is a side view of the disinfecting cap of  FIG.  12   . 
         FIG.  14    is a cross-sectional view of the disinfecting cap of  FIG.  13    along line A-A. 
         FIG.  15    is an end view of the disinfecting cap of  FIG.  12    showing an open end. 
         FIG.  16    is an end view of the disinfecting cap of  FIG.  12    showing a closed end. 
         FIG.  17    is a perspective view of a disinfecting cap exemplary embodiment showing a closed end of the cap. 
         FIG.  18    is a perspective view of the disinfecting cap of  FIG.  17    showing an open end of the cap. 
         FIG.  19    is a side view of the disinfecting cap of  FIG.  17   . 
         FIG.  20    is a cross-sectional view of the disinfecting cap of  FIG.  19    along line A-A. 
         FIG.  21    is an end view of the disinfecting cap of  FIG.  17    showing an open end. 
         FIG.  22    is an end view of the disinfecting cap of  FIG.  17    showing a closed end. 
         FIG.  23    is a perspective view of a disinfecting cap exemplary embodiment showing a closed end of the cap. 
         FIG.  24    is a perspective view of the disinfecting cap of  FIG.  23    showing an open end of the cap. 
         FIG.  25    is a side view of the disinfecting cap of  FIG.  23   . 
         FIG.  26    is a cross-sectional view of the disinfecting cap of  FIG.  25    along line A-A. 
         FIG.  27    is an end view of the disinfecting cap of  FIG.  23    showing an open end. 
         FIG.  28    is an end view of the disinfecting cap of  FIG.  23    showing a closed end. 
         FIG.  29    is a perspective, cross-sectional view of an alternative embodiment of the disinfecting cap of  FIG.  26   . 
         FIG.  30    is a perspective view of a disinfecting cap exemplary embodiment showing a closed end of the cap. 
         FIG.  31    is a perspective view of the disinfecting cap of  FIG.  30    showing an open end of the cap. 
         FIG.  32    is a side view of the disinfecting cap of  FIG.  30   . 
         FIG.  33    is a cross-sectional view of the disinfecting cap of  FIG.  32    along line A-A. 
         FIG.  34    is an end view of the disinfecting cap of  FIG.  30    showing an open end. 
         FIG.  35    is an end view of the disinfecting cap of  FIG.  30    showing a closed end. 
         FIG.  36    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  37    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  38    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  39    is a perspective view of a skirt of the disinfecting cap of  FIG.  38    showing a closed end of the skirt. 
         FIG.  40    is a perspective view of a skirt of the disinfecting cap of  FIG.  38    showing an open end of the skirt. 
         FIG.  41    is a cross-sectional, perspective view of a skirt of the disinfecting cap of  FIG.  38   . 
         FIG.  42    is a perspective view of a cap body of the disinfecting cap of  FIG.  38    showing an open end of the body. 
         FIG.  43    is a cross-sectional, perspective view of a cap body of the disinfecting cap of  FIG.  38   . 
         FIG.  44    is a cross-sectional view of a disinfecting cap exemplary embodiment. 
         FIG.  45    is a cross-sectional view of a disinfecting cap exemplary embodiment. 
         FIG.  46    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  47    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  46   . 
         FIG.  48    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  49    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  48   . 
         FIG.  50    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  51    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  50   . 
         FIG.  52    is a perspective view of a disinfecting cap exemplary embodiment showing the cap in an open configuration. 
         FIG.  53    is a perspective, cross-sectional view of a disinfecting cap exemplary embodiment. 
         FIG.  54    is a perspective, cross-sectional view of a cap body of the disinfecting cap of  FIG.  53   . 
         FIG.  55    is a perspective, cross-sectional view of a shell of the disinfecting cap of  FIG.  53   . 
         FIG.  56    is a perspective, cross-sectional view of a disinfecting cap exemplary embodiment. 
         FIG.  57    is a perspective, cross-sectional view of a cap body of the disinfecting cap of  FIG.  56   . 
         FIG.  58    is a perspective, cross-sectional view of a shell of the disinfecting cap of  FIG.  56   . 
         FIG.  59    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  60    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  59   . 
         FIG.  61    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  62    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  61   . 
         FIG.  63    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  64    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  63   . 
         FIG.  65    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  66    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  65   . 
         FIG.  67    is a perspective view of a disinfecting cap exemplary embodiment showing an open end of the cap. 
         FIG.  68    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  67   . 
         FIG.  69    is a perspective, cross-sectional view of disinfecting cap exemplary embodiment. 
         FIG.  70    is a perspective view of the disinfecting cap of  FIG.  69    showing an open end of the cap. 
         FIG.  71    is a perspective, cross-sectional view of the disinfecting cap of  FIG.  69    showing a sponge positioned in the cap. 
         FIG.  72    is a perspective view of a sponge for use with various embodiments of a disinfecting cap. 
         FIG.  73    is a perspective view of a foil seal for use with various embodiments of a disinfecting cap. 
         FIG.  74    is a cross sectional view of a Y-site having a female port. 
     
    
    
     While the invention is susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and will be described in detail herein. It should be understood, however, that the invention is not intended to be limited to the particular forms disclosed. Rather, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention. 
     DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     Embodiments of the invention are now described in detail. Referring to the drawings, like numbers indicate like parts throughout the views. As used in the description herein and throughout the claims, the following terms take the meanings explicitly associated herein, unless the context clearly dictates otherwise: the meaning of “a,” “an,” and “the” includes plural reference, the meaning of “in” includes “in” and “on.” Relational terms such as first and second, top and bottom, forward and rearward, inside and outside, interior and exterior, and the like may be used solely to distinguish one entity or action from another entity or action without necessarily requiring or implying any actual such relationship, direction or order between such entities or actions. 
     The terms “proximal” and “distal” may be used in this application when describing various embodiments. These terms are not intended to be limiting and are merely provided for ease of maintaining a consistent orientation when describing various embodiments. As used herein, proximal refers to the direction generally closer to the patient and/or medical device to be cleaned and distal refers to the direction generally farther from the patient and/or medical device to be cleaned. 
     This application provides a description of various implementations and embodiments of a device for cleaning medical implements, in particular a device for cleaning vascular or other fluid access sites. Various embodiments of the invention include a cap having an opening to receive an access site. Throughout this application illustrative embodiments refer to use of a cap to engage with a “port” as an example of such an access site. One of skill in the art would understand that the invention may also be used in conjunction with other access sites or other medical devices without access sites. 
     In addition, the terms “open end” and “closed end” may be used in this application when describing various embodiments. These terms are not intended to be limiting and are merely provided for ease of maintaining a consistent orientation when describing various embodiments. As used herein, absent a specific contradictory disclosure, “open end” refers to an end of a cap having an opening into an interior volume into which a port is inserted, regardless of the geometry of the cap. Closed end refers to an end of a cap opposite or separated from the open end and not having an opening for accepting a port. 
     The following is a non-limiting example of how such a cap may be used by a healthcare worker: the healthcare worker may, with gloved hands, open the cap packaging and place the cap over the port of a medical implement to be cleaned. In certain embodiments, the healthcare worker may wipe the site by either applying a turning motion or by simply pushing the cap onto the port. The cap could then remain secured in place by threads other mechanisms described herein. A cap in place on a medical implement may be a positive indication that a desired site of the medical implement is clean. A vibrant color or other indicia may be used to allow instant visualization of a cap&#39;s presence from a door or hallway. 
     Embodiments of the cap described herein may include a disinfecting substance, such as a solution of a suitable microbiocide or germicide. The disinfecting substance can include an anti-bacterial disinfectant of any suitable type and suitable amount depending upon the size and structure of the cap. For example, in some embodiments the disinfecting substance may be an aqueous solution including about two percent (2%) chlorhexidine gluconate (chlorhexidine solution, “CHG”). In other embodiments, a solution including about 70 percent (70%) isopropyl alcohol (“IPA”) in an aqueous solution is included in the disinfecting substance. In yet another embodiment, a solution including about 70 percent (70%) IPA and about two percent (2%) CHG in an aqueous solution is included in the disinfecting substance. In the latter solution, it is recognized that the concentration of IPA can vary from about 60 percent (60%) to about 90 percent (90%) and the concentration of CHG can vary from about one percent (1%) to about five percent (5%), in one embodiment. 
     Other suitable solution compositions and concentrations are also possible. For instance, povidone iodine, polyhexanide (polyhexamethylene biguanide, “PHMB”), benzalkonium chloride (“BAC”), chlorxylenol (“PCMX”) or hydrogen peroxide solutions can be included in the disinfecting substance of further embodiments. Throughout this disclosure, reference to one or more of these disinfecting substances in relation to a cap embodiment should be understood to disclose the use of any other appropriate disinfecting substance as disclosed herein or as would be understood by one of ordinary skill in the art. In addition, embodiments of the disinfecting substance may be in a liquid or a gel form. 
     In various embodiments of the invention described herein, the port comes in contact with the disinfecting substance in liquid or gel form, or with an absorbent material infused with the disinfecting substance. However, it may not be necessary for the surface of the port to contact the liquid or gel disinfecting substance. For example, if IPA is used as part of a disinfecting solution, IPA vapors trapped within the cap may act as a disinfectant for the port without requiring contact between the liquid solution and the site being cleaned. 
     Various materials may be used to manufacture the cap embodiments described herein. Appropriate materials may include polyurethane (“PU”), polypropylene (“PP”), polyethylene (“PE”), thermoplastic elastomer (“TPE”), thermoplastic vulcanizate (“TPV”) such as Santoprene, or other materials as would be understood by one of ordinary skill in the art. Various embodiments described herein recite the use of particular materials, but one of ordinary skill would understand that other appropriate materials could be substituted for the disclosed material. 
     Various embodiments also describe the use of sponge or foam material. Such foam may be formed of polyurethane (“PU”) or another appropriate absorbent material. Alternatively, other absorbent materials may be used in place of foam, including for example, felted non-woven or other fibrous materials. 
       FIGS.  1 - 3    show an illustrative embodiment of a disinfecting cap. The cap  100  may comprise an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. An outside surface  110  of the sidewall  106  may be generally cylindrical and may comprise a step  112  such that a first portion  114  of the sidewall has a diameter that is greater a second portion  116  of the sidewall. Alternatively, the first and second portions may have substantially the same diameter, or the first portion of the sidewall may have a diameter that is less than the diameter of the second portion. 
     The sidewall  106  may encompass an interior volume  118 . An interior surface  120  of the sidewall  106  may be generally cylindrical in a first section  122  of the interior volume. Alternatively, the interior volume may have a generally conical cross-section in the first section  122 . The interior volume may also comprise a second section  124 . The second section may comprise an open end  126  and a closed end  128 . A cross-section of the second section  124  may be spherical, semi-spherical, conical, a rounded cone, or some combination of these or other shapes. A distance  107  between the closed end  128  of the second section and the end wall  108  may vary depending on the dimensions of the cap and shape of the second section. A post  130  may extend into the interior space  118  from the closed end  128  of the second section  124 . 
     The disinfection cap  100  may comprise a single material that forms the sidewall  106  and end wall  104  in a single piece. For example, the disinfecting cap  100  may comprise a unitarily molded piece. The cap may be formed of TPV or any other appropriate material. 
     The cap may further comprise a cover or seal as illustrated in  FIG.  73    that extends across the open end  102  of the cap to seal a disinfecting substance and/or an absorbent material within the interior volume. The seal may be positioned adjacent to an end surface  154  of the interior volume  118  or may be spaced some distance into the interior volume, leaving a space between the seal and the end surface. The seal may have a first portion  408  generally shaped and sized to cover the open end  102  of the cap. The seal may further include a grip or tab  410  that aids in removal of the seal from the cap. Alternatively, the seal may include perforations, score lines or other features to aid in fracturing the seal. Such a seal may be any appropriate material including foil, polymer, etc. 
     The interior surface  120  of the first section  122  may engage an outside surface of a female luer  6802 , as shown, for example, in the Y-site  6800  illustrated in  FIG.  74   . The interior surface  120  of the cap may engage the threads  6804  of the female luer. The engagement may be made by a press or friction fit between an outside edge  6806  of the threads against the cap interior surface  120 . In such a press fit, the interior surface of the cap may deform outwardly to accommodate the threads of the female luer. Such deformation may occur by a displacement of some or all the cap sidewall  106  in an outward direction. Alternatively, deformation of the interior surface  120  may occur by compression of the sidewall material without movement or deformation of the outside surface  110 . In further alternatives, both compression and movement of the sidewall may occur on inserting the female luer into the cap. Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  1 - 3   . 
       FIGS.  4 - 6    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. An outside surface  110  of the sidewall  106  may be generally cylindrical. 
     The sidewall  106  may encompass an interior volume  118 . An interior surface  120  of the sidewall  106  may be generally cylindrical in a first section  122  of the interior volume. Alternatively, the interior volume may have a generally conical cross-section in the first section  122 . The interior volume may also comprise a second section  124 . The second section may comprise an open end  126  and a closed end  128 . A cross-section of the second section  124  may be spherical, conical, a rounded cone, or some combination of these or other shapes. A post  130  may extend into the interior space  118  from the closed end  128  of the second section  124 . 
     The disinfection cap  100  may comprise a skirt  132  that surrounds a least a portion of the sidewall  106 . An inside surface  134  of the skirt  132  may be positioned adjacent to the outside surface  110  of the sidewall  106 . The inside surface of the skirt may be adhered to the outside surface of the sidewall. A portion  136  of the sidewall  106  may extend around an end  138  of the skirt  132 . The flange  142  of the sidewall may extend to cover an outside surface  140  of the skirt. An extension  144  of the flange  142  may engage with a notch or channel  146  formed in an outer surface  140  of the skirt. The notch  146  may extend around a portion or substantially the entire circumference of the skirt. The flange  142  and notch  146  may be formed adjacent or near the closed end  104  of the cap. Alternatively, one or more tabs may extend from the skirt  132  or sidewall flange  142  that engage with corresponding indentations or the like that are formed in the corresponding surface of the sidewall extension or skirt. The skirt  132  may extend along the sidewall  106  of the cap to the open end  102 . An open-end surface  152  of the skirt may be coplanar with an end surface  154  of a cap body  148  at an open end  102  of the cap. In this manner, the skirt end surface  152  and cap body end surface  154  may form concentric rings at an open end of the cap. 
     The cap body  148  of the cap may be formed of a first material. This material may be TPV, PU, or another appropriate material. The skirt  132  may be formed of a second material. In embodiments of the cap, the second material has a higher durometer than the first material. The second material may be PP, PE, or another appropriate material. 
     The interior surface  120  of the first section  122  may engage an outside surface of a female luer  6802 , as shown, for example, in the Y-site  6800  illustrated in  FIG.  74   . The interior surface  120  of the cap may engage the threads  6804  of the female luer. The engagement may be made by a press or friction fit between an outside edge  6806  of the threads against the cap interior surface  120 . In such a press fit, the interior surface of the cap may deform outwardly to accommodate the threads of the female luer. Such deformation may occur by a displacement of some or all the cap sidewall  106  in an outward direction. Alternatively, deformation of the interior surface  120  may occur by compression of the sidewall material without movement or deformation of the outside surface  110 . In further alternatives, both compression and movement of the sidewall may occur on inserting the female luer into the cap. 
     The skirt  132  may constrain or provide reinforcement to the cap body  148 . In embodiments of the cap, the skirt may reduce or eliminate any expansion of the cap when a female luer is inserted; the skirt may increase the pressure exerted by the cap against the luer, which may result in an increased force necessary to remove the cap once it is positioned on the luer; or the skirt may have both these effects. An outer surface  140  of the skirt may comprise protuberances that extend from the outer surface such as columns  156  or tabs  158  as described in more detail elsewhere in the application. Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  4 - 6   . 
       FIGS.  7 - 11    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise a skirt  132  that surrounds a least a portion of the sidewall  106 . A skirt flange  160  may interlock or otherwise engage with a groove  162  of the cap body  148 . The skirt flange  160  may have a cross section that is narrower than the cross section of skirt wall  300  of the skirt body  302 . The flange may comprise a stepped engagement ring  304  or discrete tabs that extend outward from the flange sidewall. The engagement ring  304  may engage a corresponding cavity  306  formed in the cap body groove  162  and may comprise a tab or extension  305 . Alternatively, the cap may comprise other engagement elements formed on the skirt flange  160  that engage with corresponding elements formed in the body groove  162 , including tabs, serrations, threads, or the like. 
     In embodiments of the cap, the cap body may have a first section  312  having a first diameter, and second section  314  having a second diameter that engages an inner diameter/surface  316  of the skirt. The inner surface of the skirt may be generally cylindrical or may be in the shape of a truncated cone with the open end  384  of the surface  316  having a smaller diameter than the closed end  386 . A flange  142  of the cap body  148  may extend beyond an outer surface  310  of the skirt body  302 . Tabs  158  may extend from the skirt outer surface  310  beyond the outer surface  308  of the cap body  148 . Embodiments of the disinfecting cap may incorporate elements similar to those discussed above but not specifically labeled in or discussed with respect to  FIGS.  7 - 11   . 
       FIGS.  12 - 16    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise a skirt  132  that surrounds a least a portion of the sidewall  106 . An outer surface  308  of the of the cap body sidewall may have a uniform, cylindrical outside diameter  318  that engages an inner diameter  316  of the skirt. A section  164  of the cap body sidewall  106  may extend beyond a bottom edge  166  of the skirt. Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  12 - 16   . 
       FIGS.  17 - 22    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise a framework  168  that is positioned within or embedded in the sidewall  106  such that a part  176  of the sidewall is inside the framework and a part  178  of the sidewall is outside the framework. Alternatively, the framework may be positioned around an outer surface  170  of the sidewall  106 , and a secondary sidewall  172  may surround a framework outer surface  174 . The framework may include voids or through holes (not shown) that are filled by the material of the cap body  148  allowing the framework  168  to interlock with the cap body. An open-end surface  180  of the framework  168  may be coplanar with an end surface  154  of a cap body  148  at an open end  102  of the cap. In this manner, the framework end surface  180 , the cap body inside part end surface  182 , and the cap body outside part end surface  184  may form concentric rings at an open end of the cap. A section  192  of the framework may be concentric with or otherwise exposed at an outside surface  110  of the sidewall  106 . Columns  156  and/or tabs  158  may extend from the exposed section  192 . Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  17 - 22   . 
       FIGS.  23 - 28    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise a first ring  186  that surrounds a least a portion of the sidewall  106 . The first ring may be positioned near or adjacent the open end  102  of the cap. The cap may further comprise a second ring  188  that surrounds a least a portion of the sidewall  106 . The second ring may be positioned adjacent the closed end  102  of the cap or nearer to the closed end relative to the first ring. Columns  190  may extend between the first ring  186  and the second ring  188 . Tabs  158  may extend from an outer surface  140  of one or both rings. The columns may comprise an outer surface  322  having a generally semi-circular cross-section and an inner surface  320  that conforms to the outer surface  308  of the cap body. The column outer surface  322  may be recessed such that an outer surface  324  of the first ring  186  and an outer surface  326  of the second ring  188  extend beyond the surface  322  of the columns. The columns  190  may have a tapered cross section such that the column has a greater cross-sectional area at a first end  328  than at a second end  330 . The first and second rings may have the same outside diameter. Alternatively, the first and second rings may have different outside diameters. Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  23 - 28   . 
       FIG.  29    show a further illustrative embodiment of the disinfecting cap of  FIGS.  23 - 28   . In this embodiment, one or more of the rings  186 ,  188  may comprise an inwardly extending flange  194 . The flange may engage a groove  196  formed in an outside surface  110  of the cap body  148 . 
       FIGS.  30 - 35    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise columns  190  extending along and from an outer surface  110  of the cap body. Tabs  158  may extend along or from the outer surface  110  of the cap body  148  in a space  198  between the columns  190 . The tabs  158  may attach adjacent first ends  200  or adjacent second ends  202  of the columns  190 . Tabs may alternate between attaching first ends  200  and second ends  202 . Tabs  158   a  may extend from a centerline of adjacent columns  190 . Alternatively, tabs  158   b  may extend from an edge  159  or near to an edge of adjacent columns  190 . Both tab configurations  158   a ,  158   b  may be used. For example, longer tabs  158   a  may be used adjacent to the open end  102  of the cap body  148 , and shorter tabs  158   b  may be used adjacent to the closed end  104  of the cap body. Embodiments of the disinfecting cap may incorporate elements similar to those discussed elsewhere in the application but not specifically labeled in or discussed with respect to  FIGS.  30 - 35   . 
     As particularly illustrated in  FIGS.  36  and  37    and as shown in other figures, an outer surface  140  of the skirt may comprise protuberances that extend from the outer surface such as columns  156  or tabs  158 . The columns  156  may be of various lengths, heights, and thicknesses and may vary in number and positioning. The columns  156  may extend a full length of the exposed outside surface  334  of the skirt from a lower edge  332  of the exposed section to an upper edge  336 . Alternatively (see, e.g.,  FIGS.  4 - 6   ), the columns may extend from a lower edge  332  of the exposed section  334  of the skirt for a distance that does not extend to the upper edge  336 . The columns may provide for an enhanced grip by the user to improve control and manipulation of the cap. The tabs  158  may be of various lengths and heights and may vary in number and positioning. For example, the tabs may be positioned adjacent to the lower edge  332  of the skirt exposed section  334 . Alternatively, the tabs may be spaced apart some distance  338  from the lower edge  332 . A tab  158  may extend from one column  156   a  to an adjacent column  156   b . Alternatively, the tab may extend a distance less than the space between columns (see, e.g.,  FIGS.  4 - 6   ). The tabs may allow the cap to engage with other devices. For example, if the cap is positioned in a cavity of a syringe plunger, the tabs  158  may interlock with features of the plunger cavity to secure the cap in position until the cap is to be used on a site. 
       FIGS.  38 - 43    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The disinfection cap  100  may comprise a skirt  132  that surrounds a least a portion of the sidewall  106 . The skirt  132  may comprise a skirt side wall  340  and a skirt end wall  346 . The skirt may further comprise an outer surface  140 . The outer surface  140  of the skirt may comprise protuberances that extend from the outer surface such as columns  156  or tabs  158  as described in more detail elsewhere in the application. The skirt may further comprise an open end  342  and a closed end  344 . The closed end may have an end wall  346 . Holes, channels, or apertures  348  may extend through the end wall  346 . The end wall  346  may be generally planar, while an upper or inside surface  352  of the end wall may have a convex shape. The convex shape may be at least partially spherical or may be formed in a truncated cone shape. The inside surface  352  may have a generally planar portion  354  at a center of the inside surface. The skirt outer surface  140  may comprise a lower surface  350  of the end wall and may further comprise a step  356  between a first, upper section  358  having a first diameter and a base section  360  having different diameter. The diameter of the base section may be smaller than the diameter of the upper section. 
     The cap body  148  may comprise a cavity portion  362  and a flange portion  364 . The cavity portion may comprise a cavity or interior volume  118  extending from the open end  102 . The cavity portion may have a sidewall  106  that is surrounded, at least in part, by wall  300  of the skirt  132  such that an outside surface  366  of the cavity portion sidewall  106  is adjacent to an inner diameter  316  of the skirt sidewall  340 . Pillars or extensions  368  may extend from an outer bottom surface  370  or the cavity portion  362 . The pillars  368  extend through channels  348  formed in the skirt end wall  346 . 
     The pillars  368  may connect the cavity portion  362  with the flange portion  364 . The flange portion may comprise a bottom or end wall  380  having an inner surface  372 , an outer surface  374 , and a sidewall  376  extending from an edge  378  of the bottom wall in a direction toward the open end of the cavity portion. The sidewall  376  may be spaced and sized such that it surrounds the base section  360  of the skirt  132 . An end surface  382  of the sidewall  376  may contact or be positioned proximate the skirt step  356 . The pillars  368  may extent from the base section  360  inner surface  372  through the channels in the skirt end wall  346 . Embodiments of the disinfecting cap may incorporate elements similar to those discussed above but not specifically labeled in or discussed with respect to  FIGS.  38 - 43   . 
     The cap body cavity portion  362  and flange portion may be integrally formed. In an illustrative method of manufacturing, the skirt  132  may be injection molded from an appropriate material as discussed elsewhere in the application. The cap body  148  may then be overmolded by injection molding onto the skirt in a secondary operation. The channels  348  through the skirt allow the cap body portions to be molded in a single piece and provide for an interlocking engagement between the cap body and the skirt. 
       FIGS.  44 - 71    illustrate additional embodiments or features of a disinfecting cap. These features and embodiments may incorporate elements or features of other cap embodiments discussed herein or may be incorporated into such other embodiments. 
     As illustrated in  FIGS.  44 - 45   , an open end surface  152  of the skirt may be coplanar with an end surface  154  of a cap body  148  at an open end  102  of the cap  100 . The cap body may provide for a transition from the interior surface  120  of the interior volume  118  to the end surface  154  of the cap body. The transition may comprise a chamfer  388  ( FIG.  44   ). The chamfer  388  may extend from the interior surface  120  to the outside surface  110  of the sidewall  106  such that the chamfer forms the entire end surface  154  of the cap body. Alternatively, the chamfer may extend across only a portion of the end surface such that a section of the end surface is coplanar with the end surface  152  of the skirt. The transition may comprise a fillet  390  ( FIG.  45   ). The fillet may be sized such that a section  392  of the end surface is coplanar with the end surface  152  of the skirt. Alternatively, the fillet may be sized such that the fillet extends across substantially the entire end surface  154  of the cap body. 
       FIGS.  46 - 47    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148  having an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. The cap may comprise a membrane  204  that extends at least partial across the opening formed at the open end  102  of the cap. The membrane may comprise a hole  206  formed at its center. The membrane may comprise an elastomeric material that allows displacement of the membrane so that a site can be inserted into the cap. The membrane may be spaced some distance  402  below an end surface  154  of the cap. 
     The cap may further comprise a sponge  394  or other absorbent material that is placed in the interior  118  of the cap. The sponge may comprise a central cavity  396 . The sponge may be cylindrical with an outside diameter such that an outside surface  398  of the sponge is proximate an interior surface  120  of the cap. The central cavity may extend from a top surface  400  of the sponge for a distance that is less than the full thickness of the sponge. Alternatively, the central cavity may extend through the entire thickness of the sponge. 
       FIGS.  48 - 49    show further embodiments of a disinfecting cap. The cap  100  may comprise a membrane  204  that extends at least partial across the opening formed at the open end  102  of the cap. The membrane may comprise a slit  210  formed at or extending over a center point  212  of the membrane. The membrane may be positioned such that the membrane is coplanar with the end surface  154  of the cap. 
       FIGS.  50 - 51    show further embodiments of a disinfecting cap. The cap  100  may comprise a membrane  204  that extends at least partial across the opening formed at the open end  102  of the cap. The membrane may comprise multiple slits  210   a ,  210   b . One or more of the slits may extend over a center point  212  of the membrane. The slits may intersect at the center point. The slits may extend at a 90° angle relative to one another within the plane of the membrane. The membrane may comprise an elastomeric material that allows displacement of the membrane so that a site can be inserted into the cap. 
       FIG.  52    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise a cap body  148 . The cap body may include a first section  214  and a second section  216 . A hinge  218  connects the first and second body sections  214 ,  216  such that the cap may be snapped around a site. Each body section may contain a portion of a membrane  220 . The membrane portions may include cut-outs  222 . The membrane may separate a first cavity  404  of the cap  100  from a second cavity  406 . One or more sponges  394  may be positioned in the second cavity. The cap may comprise a latch or other engaging elements that secure the cap in a closed position. 
       FIGS.  53 - 55    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. An outside surface  110  of the sidewall  106  may be generally cylindrical. 
     The disinfection cap  100  may comprise a shell  224  that surrounds a least a portion of the sidewall  106  and the end wall  108 . An inside surface  226  of the shell  224  may be positioned adjacent to the outside surface  110  of the sidewall  106 . The inside surface of the shell may be adhered to the outside surface of the sidewall. A flange  228  may extend from an outside surface of the cap body end wall  108 . The flange  228  may engage a groove  230  formed at an inside surface  232  of the shell  224 . The flange  228  may be spaced from the cap body end wall  108  by a post section  236  that corresponds to a hole  238  formed in the shell inside surface  232 . 
     An open-end surface  234  of the shell may be coplanar with an end surface  154  of a cap body  148  at an open end  102  of the cap. In this manner, the shell end surface  234  and cap body end surface  154  may form concentric rings at an open end of the cap. 
       FIGS.  56 - 58    show a further illustrative embodiment of a disinfecting cap. The cap  100  may comprise an open end  102  and a closed end  104 . A sidewall  106  may extend between the open end and closed end. An end wall  108  may be positioned at the closed end  104  of the cap. An outside surface  110  of the sidewall  106  may be generally cylindrical. 
     The disinfection cap  100  may comprise a shell  224  that surrounds a least a portion of the sidewall  106  and the end wall  108 . An inside surface  226  of the shell  224  may be positioned adjacent to the outside surface  110  of the sidewall  106 . The inside surface of the shell may be adhered to the outside surface of the sidewall. 
       FIGS.  59 - 71    illustrate additional configuration of embodiments of the cap as discussed throughout the application. These configurations disclose different features of the embodiments, and caps consistent with these configurations may have a unitary construction as discussed with regard to the embodiment of  FIGS.  1 - 3    or may have a two-part construction as discussed with regard to the embodiment of  FIGS.  4 - 6    and others. 
       FIGS.  59 - 60    illustrate an embodiment in which columns  156  extend from a first portion  114  of the sidewall but do not extend to a second portion  116 . A post  130  may extend into the interior space  118 . Apart from the columns  156 , the first  114  and second  116  portions have substantially the same cross section. Other features of the embodiment will be apparent from the figures. 
       FIGS.  61 - 62    illustrate an embodiment in which columns  156  extend from a first portion  114  of the sidewall but do not extend to a second portion  116 . A post  130  may extend into the interior space  118 . The first  114  portion has a diameter that is larger than the second section such that a step  412  is formed between the sections. The sidewall  414  of the first portion is thicker than the sidewall  416  of the second portion  116 . An interior surface  120  of the sidewall  106  may be generally cylindrical in a first section  122  of the interior volume. The interior volume may also comprise a second section  124 . A cross-section of the second section  124  may have a rounded conical shape. Other features of the embodiment will be apparent from the figures. 
       FIGS.  63 - 64    illustrate an embodiment in which columns  156  extend from a first portion  114  of the sidewall but do not extend to a second portion  116 . A post  130  may extend into the interior space  118 . The first  114  portion has a diameter that is larger than the second section such that a step  412  is formed between the sections. The sidewall  414  of the first portion is thicker than the sidewall  416  of the second portion  116 . An interior surface  120  of the sidewall  106  may be generally cylindrical in a first section  122  of the interior volume. The interior volume may also comprise a second section  124 . A cross-section of the second section  124  may have a conical shape. Other features of the embodiment will be apparent from the figures. 
       FIGS.  65 - 66    illustrate an embodiment in which columns  156  extend from a first portion  114  of the sidewall and a second portion  116 . A raised ring or divider  418  may extend from the outer surface of the cap between the first  114  and second  116  portions. The divider  418  may have a diameter that extends beyond the surface of columns  156 . Alternatively, the divider may have a diameter that is coextensive with the highest point of the columns. An interior surface  120  of the sidewall  106  may be generally cylindrical. The interior surface  120  may comprise channels or grooves  420  formed in the surface. A groove  420   b  may extend concentrically around the interior volume  118  and/or a groove  420   a  may extend longitudinally along the interior surface. Other features of the embodiment will be apparent from the figures. 
       FIGS.  67 - 68    illustrate an embodiment in which a portion  422  the cap sidewall  106  comprises an interior section  424  and an exterior section  426  that are separated by an annular cavity  428 . The interior section  424  of the sidewall may flex outwardly when a site is inserted into the cap in order to accommodate and secure the site. Other features of the embodiment will be apparent from the figures. 
       FIGS.  69 - 71    illustrate an embodiment in which a central post  430  extends from the center of a bottom surface  432  at the closed end  128  of the cap  100 . The post may extend from the bottom surface to the open end  102  of the cap such that a top surface  434  of the post is coplanar with an end surface  154  of the side wall  106 , thereby forming and annular interior space  440 . A ring or tab protrusions  436  may extend from a side surface  438  of the post. The protrusions  436  may be positioned between the interior space bottom surface  432  and the post top surface  434 . An annular sponge  438  may be positioned in the annular interior space  440 . Other features of the embodiment will be apparent from the figures. 
       FIG.  72    illustrates an embodiment of a foam material or sponge  442  that may be positioned within the interior volume  118  of various embodiments of the cap  100 . The sponge may be generally cylindrical as shown or, alternatively, cubical, spherical, or another appropriate shape. 
     Although a few embodiments have been described in detail above, other modifications are possible. For instance, any of the embodiments described above may be sized and scaled for a particular medical implement, such as a stethoscope or otoscope. Other embodiments may be within the scope of the following claims. 
     This application provides a description of various implementations and embodiments of a device for cleaning medical implements. The various embodiments have been described as having a variety of features. It will be understood by one of ordinary skill in the art that features of the various embodiments are intended to be interchangeable, and features described in the context of one embodiment may be implemented in conjunction with a device having the features and structure of another embodiment.