Patent Publication Number: US-2011064512-A1

Title: Cleaning Tool

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation-in-part of pending U.S. patent application Ser. No. 12/491,943, filed Jun. 25, 2009, which is a continuation-in-part of U.S. patent application Ser. No. 12/167,343, filed Jul. 3, 2008, and priority is hereby claimed as to all subject matter disclosed in this application that is common to those applications, respectively. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to a tool that is useful for mechanical cleaning and/or application of fluids to an exposed or accessible attachment surface of a fluid connector device used in medical applications. 
     2. Description of Related Art 
     A significant problem that exists today in the delivery of healthcare services is the accidental transmission of pathogens and diseases from one patient to another, or from a patient or healthcare worker to another, by improperly or inadequately cleaned connectors such as those used in fluid infusion or extraction therapies. Proper and thorough cleaning of fluid connector devices and ports is essential, for example, in reducing the incidence of methycillin-resistant Staphylococcus aureus (MRSA) infections. 
     Fluid connectors of medical devices are commonly cleaned using wipes that are saturated with alcohol or another similarly effective disinfectant. The wipes are manufactured and stored in sealed pouches until the time of use, then removed manually by the user, who holds the wipe in his or her fingers and rubs the wipe against the exposed surfaces of the attachment surfaces to be cleaned. Any bacteria or pathogen that is present on the fingers of the user, typically a healthcare worker who has also been treating other patients, can be transferred to the wipe and then to the attachment surfaces of the device, or can be transferred directly to the device by inadvertent contact between the user&#39;s hand and an attachment surface. Also, because fluid connectors of the attachment devices frequently comprise a plurality of differing surfaces having various contours and degrees of exposure, a conventional wipe may not reach all portions of the surfaces when manipulated by the user. This is particularly true, for example, where the fluid connector comprises threads. 
     An improved cleaning tool for the attachment surfaces of fluid connectors used in medical applications is therefore needed that will reduce the likelihood of direct contact between the hands of the user and the surface being cleaned, that will better conform to the contours of the attachment surfaces when manipulated by the user, and that will apply pressure more evenly around the perimeter of the fluid connector being cleaned. 
     Swab pouches have recently been disclosed in United States Patent Publication Nos. 2007/0225660 A1, 2008/0038167 A1 and 2008/0039803 A1 for use in covering, protecting and disinfecting the ends of luers, luer valves, cannulas and the like. Although such pouches offer some advantages over conventional wipes, a device is still needed that can be manufactured reliably and that can be manipulated easily and effectively by a clinician to mechanically scrub and/or disinfect exposed or accessible attachment surfaces of fluid connectors used in medical applications. 
     SUMMARY OF THE INVENTION 
     A tool is disclosed that is useful for mechanically cleaning and/or applying fluids to an exposed or accessible attachment surface of a fluid connector device used in medical applications. As used herein, “fluid” is intended to include liquids, gases, and solutions, suspensions or slurries. Such fluids can include or contain, for example, vascular and/or non-vascular fluids, medicines or flowable cellular tissues, that are infused into, or extracted or collected from, a patient. As used herein, “fluid connectors” or “fluid connector devices” can include, for example, luers, hubs, threaded or unthreaded connectors, Clave® connectors, and the like. Medical applications involving fluid infusion or extraction can include, for example, intravascular, intraosseous, intracranial, hepatic, lymphatic, subcutaneous, epidural, or urinary therapies. It should be understood and will be appreciated, however, by those of ordinary skill in the art upon reading this disclosure that these examples of fluids, fluid connector devices and medical applications are not exhaustive of those in connection with which the cleaning tool of the invention can be used beneficially. 
     According to at least one embodiment of the invention, a cleaning and disinfecting tool is disclosed that preferably comprises a housing having an inside wall and an open end with a defined shape, and a flexible insert such as a sponge or other similarly effective material conforming substantially to inside wall of the housing that can be used to scrub and treat a frontal attachment with a suitable cleaner or disinfectant. The cleaning and disinfecting tool can be prepackaged in a sterile wrapper and, when removed from the package, placed over the attachment surfaces of a fluid connector device such as the attachment end of a CLAVE® connector. The cleaning and disinfecting tool can be manipulated axially and rotationally relative to the end of the frontal attachment to scrub the contacted surfaces of the connector and to apply a chemical capable of cleaning, disinfecting or otherwise decontaminating the contacted surfaces. 
     According to at least one embodiment of the invention, the housing of the subject cleaning tool is molded, thermoformed or stamped from a suitable material, most preferably a polymeric material. A flexible insert such as a chemically treated sponge is preferably disposed inside the housing and can further comprise a centrally disposed opening having interior side and end wall sections configured to receive and contact external portions of the free end of a frontal attachment as the cleaning tool is manipulated by a user. Where the flexible insert is a sponge, the sponge desirably contains an amount of cleaner or disinfectant and, optionally, one or more other additives, that is adequate for decontaminating the frontal attachment with which it is used. Both the housing and the sponge portion of the cleaning tool are desirably latex-free to avoid possible allergic reactions with either the user or a patient. 
     According to at least one embodiment of the invention, a cleaning and disinfecting tool for attachment surfaces of fluid connector devices used in medical applications is provided that comprises a housing with a defined open end and a flexible insert disposed inside the housing, the insert further comprising a cleaning or disinfecting composition that is released or releasable upon contact with one or more attachment surfaces of a fluid connector. The flexible insert can be unitarily formed or can be assembled from a plurality of elements, which elements can be either fixed or moveable relative to each other. The flexible insert can be made with or without a centrally disposed recess adapted to receive one or more attachment surfaces of a fluid connector. The flexible insert is preferably heat-staked to the inside of the housing, but can also be attached by use of any available adhesive, welding technique or other attachment method that is suitable for use with the materials and methods utilized for making the housing, flexible insert and cleaner or disinfectant. 
     According to at least one embodiment of the invention, a cleaning tool for attachment surfaces of fluid connector devices used in medical applications is provided that comprises a housing containing a flexible insert as described above, and has an attached polymeric handle with flexible side walls, a closed end and a hollow interior cavity with an open end that is in fluid communication with the flexible insert. The frangible ampule or another similarly effective fluid reservoir is desirably disposed inside handle and preferably contains an amount of cleaning and disinfecting fluid that is sufficient to partially saturate flexible insert and effectively clean and disinfect the exposed free end of a frontal attachment inserted into surrounding contact by the insert. A lever arm with a blunt edge is desirably provided on the outside of the handle to facilitate the selective application of manual force against the side wall of handle, causing it to flex sufficiently to cause fracturing of the relatively rigid sidewalls of the ampule, thereby releasing cleaning and disinfecting fluid to flow downwardly by gravity into the flexible insert. 
     According to at least one embodiment of the invention, a tool for mechanically cleaning and/or applying fluid to attachment surfaces of fluid connector devices used in medical applications is provided that comprises a generally cylindrical housing having two distinct cavities, one forwardly facing and the other rearwardly facing, with open ends and with an opening establishing fluid communication between them. A compressible, flexible insert preferably having a cellular internal structure is secured inside the forwardly facing cavity. Another substantially cylindrical receptacle having a closed rearwardly facing end and an open forwardly facing end sealed with a removable closure slidably engages the open end of the rearwardly facing housing cavity. The housing and receptacle are desirably cooperatively configured so that an application of force to the closed, rearwardly facing end of the receptacle will cause projecting prongs to dislodge the closure. When this occurs, a cleaning and/or disinfecting fluid such as isopropyl alcohol or chlorhexidine that is stored in the receptacle can flow either by gravity flow or by a piston effect as described below to saturate the flexible insert immediately prior to contacting the insert with the attachment surfaces of the fluid connector device being cleaned. 
     According to at least one embodiment of the invention, a tool for mechanically cleaning and/or applying fluid to attachment surfaces of fluid connector devices used in medical applications is provided that comprises: a generally cylindrical housing, two flexible polymeric foam inserts, a liquid cleaner, and a releasable cover. The housing further comprises one closed end, one open end and sidewalls (most preferably fluted) that taper outwardly between the closed and an annular recess disposed adjacent to the open ends, with a substantially horizontal, annular flange disposed around the open end adjacent to the annular recess. The inserts include two substantially cylindrical, flexible foamed inserts insertable into the housing and capable of absorbing liquid and then expelling liquid when subsequently compressed; and a flexible sealing web substantially impervious to fluid migration through the web, said web being releasably attachable to the annular flange disposed around the open and further comprising a tab overhanging the flange on at least one side to facilitate manual grasping for removal. One flexible foam insert is desirably insertable into the housing below the annular recess and is maintained therein by any suitable means, most preferably by heat staking to prevent the insert from rotating freely inside the housing during use. That insert preferably comprises a slit or void capable of receiving an attachment surface of a fluid connector for cleaning and scrubbing. The other insert is preferably disk-shaped, has a slightly larger diameter, and is secured in substantially fixed relation to the underside of the web in such position that the insert is insertable into the annular recess adjacent to the open end of the housing when the web is releasably sealed to the annular flange of the housing. A therapeutically effective amount of a cleaning and/or disinfecting fluid is desirably placed inside the housing prior to applying the sealing web as a closure for the device. Upon removal of the web just prior to use, the liquid-containing disk-shaped insert attached to the underside of the web can be used for topical cleaning of skin, an exposed surface of an object, or an attachment surface of a fluid connector as desired in addition to use of the liquid-containing flexible insert disposed inside the housing. 
     According to at least one embodiment of the invention, another tool is disclosed that can be used for both topical cleaning of skin or an exposed surface, and for mechanically cleaning and/or applying fluid to attachment surfaces of fluid connector devices used in medical applications. The subject tool preferably comprises structural elements as described in Paragraph 0012 above except that it desirably comprises only a single, liquid-absorbing, flexible foamed polymeric insert having a cylindrical base that is preferably heat-staked into the annular recess of the housing. The upwardly projecting portion of the insert preferably further comprises a slit or recess to facilitate use as a cleaning tool for attachment surfaces of fluid connector devices used in medical applications. Prior to sealing, the insert projects upwardly past the otherwise open end of the housing. Prior to heat-staking, a cleaning and/or disinfecting liquid is desirably introduced into the housing. After attachment of the insert to the annular recess of the housing, the flexible foam insert is desirably compressed inside the housing and the web is releasably sealed to the flange to cover the opening and maintain the insert in its compressed state pending use. When the web is later removed just prior to use, and the insert is substantially saturated with the cleaning liquid, the insert expands to its projecting position to facilitate use as a topical cleaning or disinfecting tool. The slit or recess in the upwardly facing portion of the insert can receive at least a portion of the attachment surfaces of a fluid connector or outer surfaces of another device, and the upwardly projecting portion of the insert can be forced back down inside the housing, where the sidewalls provide resistance and facilitate scrubbing the attachment surfaces. 
     According to at least one embodiment of the invention, a cleaning tool for medical devices is disclosed that comprises a substantially cylindrical housing having an open end, a closed end, and a sidewall disposed between the open end and closed end. A sponge, preferably substantially cylindrical, and a treating liquid are desirably disposed inside the housing. A positioning collar is desirably configured to receive and constrain the sponge and to be inserted into and seated inside the housing between the open end and the closed end. The positioning collar is preferably seated transversely to a longitudinal axis through the housing and substantially parallel to the open and closed ends. The positioning collar desirably has a comparatively narrow, radially extending gap that communicates with a centrally disposed aperture through the collar. The gap is desirably sufficiently wide to permit insertion of a constricted section of the sponge through it, after which the positioning collar can be inserted into and seated inside the housing, thereby also releasably constraining the sponge inside the housing. In at least a portion of the interior sections of the housing that are disposed ahead of and behind the seated positioning collar (or above and below it, depending upon how the subject cleaning tool is oriented), the sponge will desirably expand approximately to the full inside diameter of the housing. This is particularly true for those portions of the sponge that are closest, respectively, to the two ends of the housing. The portions of the sponge nearer to the positioning collar will, however, remain more constricted. 
     The inside diameter of the aperture in the positioning collar is desirably slightly greater than the largest transverse dimension of that part of the device that is to be cleaned using the tool of the invention. After the sponge and positioning collar are seated inside the housing, the housing can be partially filled with sufficient liquid treating chemical to substantially saturate the sponge prior to use. A manually releasable, fluid-tight seal is then applied over the open end of the housing to cover the opening and seal the cleaning liquid inside the tool. 
     During use of this embodiment of the invention, the subject cleaning tool is desirably inverted prior to removing the liquid seal so that the cleaning liquid can saturate the sponge. When the seal is removed from the cleaning tool, the forwardly extending tip of a device to be cleaned is desirably inserted into the housing against the sponge. As the forwardly extending tip of the device approaches the positioning collar, the sponge partially collapses around the side of the device being cleaned and moves toward the center of the tool. As the tip of the device being cleaned is forced through the aperture of the positioning collar, the sponge is further squeezed around the device, at which time rotation of the cleaning tool relative to the device will cause the sponge to scrub both the end and sides of the portion disposed inside the tool. Further movement of the tip into the housing can cause the sponge to pass through the aperture of the positioning collar into a position behind the collar, where the sponge is no longer diametrically constrained by the collar. Upon withdrawal of the device from the cleaning tool, the sponge is largely or totally retained inside the closed end of the housing by the positioning collar, preventing any further contamination by possible contact between the “dirty” sponge and the hands of the user. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The apparatus of the invention is further described and explained in relation to the following drawings wherein: 
         FIG. 1  is a perspective view of a housing that is part of a tool of the invention that is useful for cleaning and disinfecting the exposed attachment surfaces of a frontal attachment device such as, for example, a CLAVE® connector, to another medical device such as, for example, a needleless syringe; 
         FIG. 2  is a top plan view of the housing of  FIG. 1 ; 
         FIG. 3  is a front elevation view of the housing of  FIG. 1 ; 
         FIG. 4  is a side elevation view of the housing of  FIG. 1 ; 
         FIG. 5  is a bottom plan view of the housing of  FIG. 1 ; 
         FIG. 6  is a cross-sectional elevation view taken along line  6 - 6  of  FIG. 2 ; 
         FIG. 7  is a perspective view of one embodiment of chemically treated cleaning sponge that is insertable into and attachable to the housing of  FIG. 1 ; 
         FIG. 8  is a top plan view of the chemically treated cleaning sponge of  FIG. 7 ; 
         FIG. 9  is a cross-sectional elevation view taken along line  9 - 9  of  FIG. 8 ; 
         FIG. 10  is a cross-sectional elevation view of a cleaning and disinfecting tool of the invention; 
         FIG. 11  is a front elevation view, partially in section and partially broken away, of the tool of  FIG. 10  being used to clean and disinfect the attachment surfaces of a fluid connector device; 
         FIG. 12  is a perspective view of another embodiment of a tool useful for cleaning and disinfecting the exposed attachment surfaces of a fluid connector device such as, for example, a CLAVE® connector, to another medical device such as, for example, a needleless syringe; 
         FIG. 13  is an exploded perspective view illustrating the component parts of the tool of  FIG. 12 ; 
         FIG. 14  is a front elevation view of the tool of  FIG. 12 ; 
         FIG. 15  is a bottom plan view of the tool of  FIG. 12 ; 
         FIG. 16  is a cross-sectional elevation view taken along line  16 - 16  of  FIG. 14 , showing the central portion of the sponge in a first position; 
         FIG. 17  is a cross-sectional elevation view substantially as shown in  FIG. 16 , but with the central portion of the sponge in a second position that is elevated in relation to the first position; 
         FIG. 18  is a perspective view of a chemically treated cleaning sponge that is configured differently from the sponge depicted, for example, in  FIG. 13 ; 
         FIG. 19  is a cross-sectional elevation view of another embodiment of a tool of the invention that is similar to the tool of  FIG. 16  but includes a housing that is configured to receive a chemically treated cleaning sponge having a configuration like that of the sponge shown in  FIG. 18 ; 
         FIG. 20  is a top perspective view of an array comprising a plurality of housings suitable for use in making an embodiment of the cleaning tool of the invention prior to separating them from a web connecting them during manufacture; 
         FIG. 21  is front elevation view of a single housing that has been inverted following separation from the array of  FIG. 20 ; 
         FIG. 22  is a cross-sectional elevation view taken along line  22 - 22  of  FIG. 21 ; 
         FIG. 23  is bottom plan view of the housing of  FIG. 21 ; 
         FIG. 24  is an exploded bottom perspective view of a cleaning tool made using the housing of  FIG. 21  in combination with a flexible insert; 
         FIG. 25  is a cross-sectional elevation view taken along line  25 - 25  of  FIG. 24 ; 
         FIG. 26  is a front elevation view, partially in section, of the tool of  FIG. 24  being used to clean and disinfect the attachment surfaces of a fluid connector; 
         FIG. 27  is an inclined view, partially in section, of another embodiment of the subject cleaning tool being used to clean and disinfect the attachment surfaces of a fluid connector, the tool comprising a handle with a reservoir containing a cleaning and disinfecting composition that is selectively releasable into the flexible insert; 
         FIG. 28  is a perspective view of another embodiment of the subject cleaning tool; 
         FIG. 29  is an exploded perspective view of the cleaning tool of  FIG. 28 ; 
         FIG. 30  is a front elevation view of the cleaning tool of  FIG. 28 ; 
         FIG. 31  is a top plan view, partially broken away, of the cleaning tool of  FIG. 28 ; 
         FIG. 32  is a cross-sectional front elevation view of the cleaning tool of  FIG. 28  prior to use; 
         FIG. 33  is a cross-sectional front elevation view of the cleaning tool of  FIG. 28  after the fluid receptacle is depressed relative to the housing to dislodge the stopper and release the cleaning and disinfecting fluid; 
         FIG. 34  is a cross-sectional front elevation view taken along line  34 - 34  of  FIG. 31 , in which the fluid receptacle is exploded upwardly relative to the housing; 
         FIG. 35  is a top plan view, partially broken away, of a preferred embodiment of another cleaning tool, having a single longitudinally extending slot in the housing; 
         FIG. 36  is a cross-sectional front elevation view taken along line  36 - 36  of  FIG. 35 , in which the fluid receptacle is exploded upwardly relative to the housing; 
         FIG. 37  is a cross-sectional front elevation view of the housing of another cleaning tool of the invention; 
         FIG. 38  is a cross-sectional front elevation view of the housing of  FIG. 37 , with a cleaning fluid disposed inside a receptacle in the housing and a closure sealing the opening of the receptacle; 
         FIG. 39  is a is a cross-sectional front elevation view of a cleaning tool of the invention, comprising the housing of  FIG. 37  and the cleaning fluid and closure of  FIG. 38 , with an absorbent flexible insert disposed inside the portion of the housing below the closure; 
         FIG. 40  is a bottom perspective view of the flexible insert of  FIG. 39 ; 
         FIG. 41  is bottom perspective view of the closure of  FIGS. 38 and 39 ; 
         FIG. 42  is an enlarged detail view taken from a position substantially as shown in  FIG. 37 ; 
         FIG. 43  is a bottom perspective view of another closure as shown in  FIGS. 44-46 ; 
         FIG. 44  is a is a cross-sectional front elevation view of another cleaning tool of the invention; 
         FIG. 45  is a cross-sectional front elevation view of the cleaning tool of  FIG. 44  that is taken transversely to the cross-sectional view in  FIG. 44 ; 
         FIG. 46  is a cross-sectional front elevation view of the cleaning tool of  FIG. 44  being used to clean the attachment end of a fluid connector; 
         FIG. 47  is a bottom perspective view of a flexible insert as shown in  FIGS. 44-46 ; 
         FIG. 48  is a cross-sectional front elevation view of an embodiment of another cleaning tool of the invention; 
         FIG. 49  is a top perspective view of an embodiment of another cleaning tool of the invention; 
         FIG. 50  is an exploded view of the cleaning tool of  FIG. 49 ; 
         FIG. 51  is front elevation view of the cleaning tool of  FIG. 49 ; 
         FIG. 52  is an enlarged cross-sectional view taken along  FIG. 52-52  of  FIG. 51 ; 
         FIG. 53  is an exploded view as in  FIG. 52  but showing the closure web and attached disk-shaped flexible insert displaced above the housing and another substantially cylindrical flexible insert; 
         FIG. 54  is a top view of the cleaning tool of  FIG. 49 ; 
         FIG. 55  is a top perspective view of another cleaning tool of the invention; 
         FIG. 56  is a front elevation view of the cleaning tool of  FIG. 55 ; 
         FIG. 57  is an exploded view of the cleaning tool of  FIG. 55 ; 
         FIG. 58  is an enlarged cross-sectional view taken along line  58 - 58  of  FIG. 56 ; 
         FIG. 59  is an exploded view as in  FIG. 58  but showing the closure web displaced above the housing and the liquid-saturated compressible foam insert projecting upwardly from the housing; 
         FIG. 60  is a perspective view of another cleaning tool of the invention wherein the subject tool has a removable cover disposed over the open end of the housing to prevent fluid leakage or evaporation prior to use; 
         FIG. 61  is an exploded view of the cleaning tool of  FIG. 60  except that no cleaning or disinfecting fluid is depicted in this view; 
         FIG. 62  is a perspective view of a cylindrical sponge element disposed so that it is held by a ring-like element prior to seating the ring-like element and the sponge material inside the housing of the cleaning tool of  FIG. 60 ; 
         FIG. 63  is an inverted cross-sectional elevation view of the cleaning tool of  FIG. 60 , showing a cleaning and/or disinfecting liquid disposed beneath the sponge element; 
         FIG. 64  is a perspective view of the cleaning tool of  FIG. 60 , with the removable cover partially peeled back during removal; 
         FIG. 65  is a bottom plan view of the cleaning tool of  FIG. 60 ; 
         FIG. 66  is a front elevation view, partially in cross-section and partially broken away, of the cleaning tool of  FIG. 60 , with the male threaded end of a medical device inserted partially into the housing and the sponge material collapsing around the front end of the device; 
         FIG. 67  is an elevation view substantially as in  FIG. 66 , but showing the cleaning tool being rotated around the forwardly extending portion of the medical device being cleaned; 
         FIG. 68  is an elevation view substantially as in  FIGS. 65 and 66 , but with the forward extending portion of the medical device being pushed farther into the housing of the subject cleaning tool, thereby pushing the entire sponge element through the aperture in the ring-like element seated inside the housing; and 
         FIG. 69  is an elevation view substantially as in  FIGS. 66-68 , but showing the medical device being withdrawn through the open end of the housing of the subject cleaning tool. 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to  FIGS. 1-6 , a preferred embodiment of the cleaning and disinfecting tool of the invention comprises housing  10  that is preferably unitarily molded, stamped or thermoformed from a polymeric composition, thin metallic material or laminate. If molded or thermoformed, housing  10  preferably comprises a polymeric material that can be glued or sonically welded. Housing  10  preferably further comprises projecting tab or handle  12  that is easily graspable by a user, and a substantially cylindrical body having coaxially aligned upper body section  14  and adjacent lower body section  16 . It should be appreciated that “substantially cylindrical,” as used in this disclosure, can include sections having different inside or outside diameters and such slopes or tapers as may be needed or appropriate in view of the particular configuration and the method and material of construction that are used in making housing  10 . Taken together, upper and lower sections  14 ,  16  define an open interior space  20  having a stepped inside diameter, with upper section  14  preferably having an inside diameter that is less than the inside diameter of lower section  16 . Lower section  16  preferably comprises an open end opposite upper section  14  that is surrounded and stabilized by flange  18  having annular face  22 . Upper body section  14  further comprises closed end wall  28  connected to handle  12 . The transition between upper and lower body sections  14 ,  16  is preferably defined by inclined annular shoulder  26  at the interior edge of annular stop surface  24 . 
     Referring to  FIG. 10 , a preferred embodiment of tool  44  of the invention is made by inserting and preferably securing a flexible insert such as a compressible sponge  30  inside open interior space  20  of the cylindrical body of housing  10 , as discussed above in relation to  FIGS. 1-6 . Sponge  30  can be secured inside opening  20  of housing  10  by any suitable means such as, for example, by use of an adhesive. Desirably, sponge  30  will be constrained inside housing  10  sufficiently that sponge  30  (and especially its outside wall) will not be easily rotatable or translatable relative to the inside walls of housing  10  once sponge  30  is installed. This will facilitate the use of rotational and axial movement of tool  44 , applied through handle  12 , to clean and scrub the exterior attachment surfaces of a frontal attachment device as described in greater detail below in relation to  FIG. 11 . Alternatively, it will be appreciated by those of ordinary skill in the art upon reading this disclosure that the structure of housing  10  can be modified by the addition of other structural elements to constrain the movement of sponge  30  relative to the inside walls of housing  10  frictionally and without the use of an adhesive if desired. 
     Referring again to  FIGS. 10-11 , sponge  30  preferably has a configuration that is receivable within the cylindrical body of housing  12 , and that also comprises an opening having a defined shape into which the attachment surfaces at the free end of a frontal attachment device such as a CLAVE® connector are receivable for cleaning and disinfecting. Sponge  30  is desirably made of a compressible, open-cell material adapted to receive, retain and release a composition containing a disinfectant when sponge  30  is placed in contact with or compressed against an attachment surface of a frontal attachment device such as a CLAVE® connector. Most preferably, sponge  30  will comprise open-cell polyurethane foam or another similarly effective non-latex, open-cell material. The dimensions and configuration of sponge  30  are desirably such that sponge  30  can be positioned and secured snugly inside housing  10 , and, with some compression, will receive and contact substantially all the surface area of the attachment surfaces of a frontal attachment device to promote cleaning and disinfecting of the attachment surfaces. 
     Although the flexible insert disposed inside the housing of the invention is principally referred to as a “sponge” throughout this disclosure, it should be appreciated by those of ordinary skill in the art upon reading this disclosure that other similarly effective molded, woven, porous or layered materials can likewise be used within the scope of the invention provided that such materials are capable of retaining prior to use and subsequently releasing during use an amount of cleaning chemical or disinfectant that is effective for decontaminating any contacted surfaces of a frontal attachment to a medical device with which the subject tool is used. In some cases it can be desirable for a cleaning agent or disinfectant to be adsorbed into or encapsulated in recesses or voids disposed inside the flexible insert of the invention. 
     Referring again to  FIGS. 6-10 , sponge  30  preferably comprises upper cylindrical section  32 , lower cylindrical section  34 , top surface  36  that abuts and can be adhered to end wall  28  of housing  10 , annular surface  38  that abuts and can be adhered to annular stop surface  24  of housing  10  and interior space  42  having an opening defined by bottom surface  40  of lower cylindrical section  34 . Although upper and lower cylindrical sections  32 ,  34 , respectively, of sponge  30  are depicted in  FIGS. 9 and 10  as being two distinct elements, it should be appreciated that they can be unitarily formed, or formed separately and joined by any suitable means known to those of ordinary skill in the art, such as, for example, by thermal or other welding techniques, by the use of commercially available adhesives, or the like. Alternatively, as discussed below in relation to  FIGS. 12-17 , the 
     Referring to  FIGS. 9-11 , when tool  44  is removed from its own sterile wrapper, sponge  30  is preferably already impregnated, substantially saturated or coated with a sufficient amount of a disinfectant-containing composition, most preferably isopropyl alcohol or another similarly effective liquid or powder, to achieve a desired level of decontamination. Tool  44  is then preferably used by placing it over the attachment surfaces  48  of a frontal attachment device, such as a CLAVE® connector that is already connected by tubing  52  to an extension set or IV catheter (not shown). Once attachment surfaces  48  are disposed inside the interior space  42  of tool  40 , the inwardly facing side and end walls of sponge  30  are desirably compressed sufficiently to contact all the external area of attachment surfaces  48 , and upon compression, will release the disinfectant-containing composition disposed inside sponge  30  directly onto attachment surfaces  48 . By grasping handle  12 , tool  44  can then be manipulated by the user to scrub attachment surfaces  48  by reciprocating tool  48  in an axial direction as demonstrated by arrows  54  and rotationally as indicated by arrows  56 . Such scrubbing is believed to provide better and more effective cleaning and disinfecting than is achievable using prior art alcohol wipes or napkins. 
     Although one embodiment of the apparatus of the invention that is particularly intended for use with the attachment surfaces of CLAVE® connectors is disclosed above, it will be appreciated that other alterations and modifications of the invention will likewise become apparent to those of ordinary skill in the art upon reading this specification in view of the accompanying drawings, and it is intended that the scope of the invention disclosed herein be limited only by the broadest interpretation of the appended claims to which the inventors are legally entitled. 
     For example, referring to  FIGS. 12-17 , another preferred embodiment of the invention is disclosed wherein cleaning and disinfecting tool  60  further comprises housing  62  and a flexible insert  64  that is retained inside housing  60  by retainer ring  74 . Retainer ring  74  can be snapped or pressed into an annular recess  82  on the inside of flange member  72 . In this embodiment, housing  62  comprises upper portion  66 , lower portion  68  having a plurality of circumferentially spaced, radially extending ribs  70 , and flange  72 . The external portions of radially extending ribs  70  provide a gripping surface for the user, and the internal portions of ribs  70  assist in resists rotational movement of flexible insert  64  inside housing  62 . Although lower portion  68  of housing  62  as shown is substantially cylindrical, it should be appreciated that housings having other polygonal cross-sections can likewise be used in the cleaning and disinfecting tools of the invention. 
     Referring to  FIGS. 13 ,  16  and  17 , flexible insert  64  comprises an outer section  76  having a centrally disposed cylindrical bore that is plugged by cylindrical element  78 . Outer section  76  has an octagonal perimeter defined by a plurality of flat surfaces  84 , each of which is preferably sized and configured to conform substantially to and cooperate with internal ribs  70  of housing  62  to resist rotational movement of outer section  76  relative to lower portion  68  of housing  62  as cleaning and disinfecting tool  60  is manipulated by a user while cleaning a frontal attachment. As with cleaning and disinfecting tool  44  described above in relation to  FIG. 11 , tool  60  is also desirably manipulated both axially and rotationally relative to a frontal attachment during use. Although a lower portion  76  having a hexagonal perimeter is a preferred structure for use in the invention, other polygonal configurations can also be used within the scope of the invention provided that any flexible insert so configured will conform substantially to and cooperate with the inside structure and configuration of the associated housing so that the resultant cleaning and disinfecting tool can function substantially as disclosed herein. Flexibility is desired to permit the surfaces that engage a frontal attachment during use to flex around and contact various portions of the frontal attachment. 
     Flexible insert  64  desirably comprises any suitable material substantially as disclosed above for use in making sponge  30  of the invention, and is desirably sufficiently compressible to be inserted into defined interior space  80  of housing  62 . If desired, adhesive can also be used to help hold flexible insert  64  in place. Retainer ring  74  is desirably seated in annulus  82  of housing  62 , and is preferably pressed or snapped into position to assist in maintaining outer section  76  of flexible insert  64  in a preferred axial position inside housing  62  during use. Retainer ring  74  can be made of rubber, plastic or metal, and can be continuous, contain a gap, or comprise projections or bosses that cooperate with housing  62  to retain ring inside annular recess  82 . 
     As shown in  FIGS. 16 and 17 , cylindrical element  78  is preferably made of the same flexible, compressible material as outer section  76  of flexible insert  64 . As shown in  FIG. 16 , cylindrical element  78  is axially positioned so that its top and bottom ends are substantially flush with the corresponding ends of outer section  76 , and interior  86  of upper portion  66  is open. Then, when cleaning tool  60  is pressed against the tip of a frontal attachment, cylindrical element  78  can slide upwardly relative to outer section  76  until cylindrical element  78  engages the closed end wall of upper portion  66 . This provides a substantially cylindrical space  88  inside housing  62  where portions of flexible insert  64  face the frontal attachment on three sides in substantially the same way as is depicted in  FIG. 11 . 
     Still another preferred embodiment of the invention is depicted and described in relation to  FIGS. 18-19 . Flexible insert  90  can be made of materials as described above in relation to other preferred flexible inserts or sponges of the invention, and like flexible insert  64 , comprises an outer section  94  having a polygonal perimeter that is preferably sized and configured to cooperate with internal portions of housing  104  to resist rotational movement of outer section  94  relative to lower portion  108  of housing  104  as cleaning and disinfecting tool  102  is manipulated by a user while cleaning a frontal attachment. In this embodiment, however, cylindrical element  92  is initially disposed above the top of outer section  94 , and a cylindrical open space  100  is disposed below it to receive a portion of a frontal attachment (not shown) that is inserted inside it during use. Cylindrical element  92  preferably seats against end wall  106  of housing  104 , and can be unitarily made with outer section  94  or not, as desired. 
     As with cleaning and disinfecting tool  44  described above in relation to  FIG. 11 , tool  102  is also desirably manipulated both axially and rotationally relative to a frontal attachment during use. Although a lower portion  94  having a hexagonal perimeter comprising side walls  96  is a preferred structure for use in the invention, either cylindrical or other polygonal configurations can also be used within the scope of the invention for either the upper or lower portions of housing  104  provided that any flexible insert so configured will cooperate with the inside structure and configuration of the associated housing so that the resultant cleaning and disinfecting tool can function substantially as disclosed herein. Flexibility is desired to permit the surfaces that engage a frontal attachment during use to flex around and contact various portions of the frontal attachment. If desired, either element  92  or outer portion  94 , or both can also be attached to the inwardly facing surface of sidewall  108  of housing  104 . As with housing  62 , side wall  108  of housing  104  can also function as a handle for use in manipulating cleaning and disinfecting tool  102  relative to a frontal attachment. 
       FIG. 20  depicts an array  120  of polymeric housings  122  suitable for use in making an embodiment of the cleaning tool of the invention. As shown, housings  122  are interconnected by a substantially continuous web from which they can be separated by any suitable conventional method or device such as, for example, by die cutting around the phantom lines that are intended to represent the flange perimeters of each respective housing as described below. Depending upon the material of construction, the depth of each housing  122 , and the side wall configuration of each, array  120  can be injection molded, thermoformed, or otherwise fabricated using known manufacturing methods. Referring to  FIGS. 21-23 , each housing  122  preferably further comprises annular flange  124  around an opening of defined shape, a continuous, substantially cylindrical side wall  126 , bottom  128 , and an inside wall comprising a plurality of flutes  130 . 
     Referring to  FIGS. 24-26 , housing  122  as described above is desirably configured to receive a flexible insert  132 , most preferably made from a resilient, spongy or elastomeric material having a side wall  134  that is compressible to facilitate insertion into interior space  125  of housing  122 , whereupon side wall  134  desirably expands slightly to conform substantially to the inside wall of housing  122  and into engagement with flutes  130 , or to be heat-staked to some portion of the wall, or to a shelf or other surface adjacent to the wall. Alternatively, other functionally equivalent methods of attachment, such as sonic welding, gluing or the like, can also be used. Where flexible insert  132  is attached to the wall, the presence of flutes or other irregularities on the surface of the inside wall are not needed to resist rotational movement of the insert inside the housing, although surface texturing on the outside can still be desirable to facilitate gripping. The insertion of flexible insert  132  into housing  122  forms cleaning tool  150 , which can then be impregnated or at least partially saturated with a composition as previously described that is suitable for use in cleaning and disinfecting a frontal attachment. A slit  140  can be provided in facing surface  136  of flexible insert  132  and continuing upward to continuous web  144  to create opposed facing surfaces  142  that permit the insertion of frontal attachment  152  into cleaning tool  150  as shown in  FIG. 26 . As shown, frontal attachment  152  is a CLAVE® connector attached to tubing segment  158 . The forwardly extending threaded portion of frontal attachment  152  is desirably cleaned by manipulating cleaning tool  150  up and down as indicated by opposed arrows  156 , and by manually rotating cleaning tool  150  relative to frontal attachment  152 . 
     Another preferred embodiment of the invention is disclosed in relation to  FIG. 27 . According to this embodiment of the invention, cleaning tool  160  is shown in relation to frontal attachment  194  attached to tubing segment  196 . Cleaning tool  160  preferably further comprises a housing  186  containing a flexible insert  188 , and has an attached polymeric handle  162  with flexible side walls, a closed end  164  and a hollow interior cavity with an open end  166  that is in fluid communication with flexible insert  188 . Frangible ampule  180  or another similarly effective fluid reservoir is desirably disposed inside handle  162  and preferably contains an amount of cleaning and disinfecting fluid  182  that is sufficient to partially saturate flexible insert  188  and effectively clean and disinfect the exposed free end of frontal attachment  194 . Lever arm  168  with blunt edge  170  is desirably provided on the outside of handle  162  to facilitate the selective application of manual force against the side wall of handle  162 , causing it to flex sufficiently to cause fracturing of the relatively rigid sidewalls of ampule  180 , thereby releasing cleaning and disinfecting fluid  182  to flow downwardly by gravity into flexible insert  188 . 
     Referring to  FIGS. 28-34 , according to another preferred embodiment of the invention, a tool  200  for contacting and/or applying a fluid to attachment surfaces of fluid connector devices used in medical applications is provided that comprises a generally cylindrical housing  202  having two distinct cavities with open ends and with an opening  228  establishing fluid communication between them. A flexible insert  204  is desirably secured to the inside wall of the forwardly facing cavity by use of an adhesive or other similarly effective means. Substantially cylindrical fluid receptacle  212  having a closed rearwardly facing end and an open forwardly facing end sealed with a removable stopper  216  slidably engages the open end of the upper cavity. Fluid receptacle  212  is preferably made of plastic but, alternatively, can be made of a different material, such as glass. Removable stopper  216  is preferably made of a rubber but, alternatively, can be made of another similarly effective polymeric material, cork, or a rupturable membrane that is substantially impermeable to the liquid contained in receptacle  212 . Housing  202  and fluid receptacle  212  are desirably cooperatively configured so that an application of manual force against the closed, rearwardly facing end of receptacle  212  will cause stopper  216  to be dislodged from the opening at the lower end upon contact with prongs  230 ,  232 , which can be of the same or different lengths. When stopper  216  is dislodged, a cleaning and disinfecting fluid  220  stored in the receptacle can flow through opening  228  between the two cavities of housing  202  to saturate flexible insert  204  prior to contacting the insert with the frontal attachment to be cleaned. A removable flexible seal or cover  206  is desirably provided over flange  208  at the open end of the forwardly facing cavity of housing  202  to prevent inadvertent contamination of flexible insert  204  prior to use. 
     Referring particularly to  FIGS. 31-33 , prongs  230 ,  232  or one or more other similarly effective structural members are desirably provided in the rearwardly facing cavity of housing  202  to assist in dislodging stopper  216  from its normal sealing position across the opening at the bottom of fluid receptacle  212  when receptacle  212  is moved forwardly relative to housing  202 . The use of one longer prong  230  at one side of stopper  216  is particularly preferred because it concentrates the manual force being applied downwardly on receptacle  212  on a limited area to assist in dislodging stopper  216  to release cleaning and disinfectant  220  to flow through opening  228  into the porous, spongy flexible insert  204 . When two or more prongs  230 ,  232  are used, a combination of one longer prong with the remainder of the prongs being spaced apart circumferentially and slightly shorter than the first will help maintain stopper  216  in a nearly horizontal position, thereby causing stopper  216  to function as a piston that will help force released liquid that has moved past stopper  216  through opening  228  and into flexible insert  204 . 
     Referring particularly to FIGS.  29  and  31 - 34 , according to a particularly preferred embodiment of the invention, structure is provided that prevents fluid receptacle  212  from being depressed relative to housing  202  prematurely, thereby causing stopper  216  to be dislodged from the opening at the bottom end of receptacle  212 , until such time as it is desired to saturate flexible insert  204 . The rear cavity of housing  202  preferably further comprises two parallel, longitudinally extending slots  222 ,  224  that cooperate with lug  214  on the lower circumference of receptacle  212  to allow receptacle  212  to be fully depressed only when lug  214  of receptacle  212  is rotationally aligned with longer channel  224 . This is desirably achieved by rotating receptacle  212  slightly while grasping housing  202  with the other hand to reposition lug  214  from alignment with channel  222  into alignment with longer channel  224 . 
     Referring to  FIGS. 35 and 36 , a cleaning tool  200 ′ is disclosed that is in all respects like that previously described in relation to  FIGS. 28-34  except that it has only a single longitudinally extending slot  224  and does not include shorter slot  222  as described in relation to the embodiment of  FIGS. 28-34 . Accordingly, receptacle  212  is not rotatable relative to housing  202 , and the tool is activated by forcing receptacle  212  toward prongs  230 ,  232  until closure  216  is displaced, allowing fluid  220  to flow into flexible insert  204 . Cleaning tool  200 ′ is then ready for use when flexible seal or cover  206  is removed. 
     Referring to  FIGS. 37-43 , another preferred embodiment of the invention is disclosed wherein cleaning tool  252  comprises a unitary housing with upper and lower sections  254 ,  256 , respectively. Upper section  254  defines cavity  258  having a closed end  260  and an open end defined by annular collar  264 . Collar  264  preferably has tapered shoulders  282 ,  283  (seen in  FIG. 42 ) to facilitate introduction and removal of a tool during molding of the housing, and to facilitate placement and removal of closure  270 . Lower section  256  comprises cavity  262  having a bottom opening with an annular flange  266  that further comprises an annular recess  268 . Housing  252  is desirably unitarily molded from any suitable polymeric resin and is then inverted to introduce cleaning and/or disinfecting liquid  274  into cavity  258 . Because liquids are substantially incompressible, sufficient headspace should be left unfilled in cavity  258  to permit the subsequent disengagement of closure  270  from collar  264  as described below. 
     After liquid  274  is in place inside cavity  258 , removable closure  270  is desirably installed to seal the opening defined by annular collar  264 . Removable closure  270  is preferably made of an elastomeric or compressible polymeric material to provide a fluid-tight seal when engaged with annular collar  264 . Although the use of a removable closure is preferred, it should be understood that any similarly effective means for sealing liquid  274  into cavity  258  can likewise be used provided that it can be perforated, dislodged or otherwise modified to permit the release of liquid  258  prior to use of tool  252 . Following installation of closure  270 , flexible insert  276  is desirably inserted into cavity  262  of lower section  256 , and is attached to the inside wall of lower section  256  by heat-staking or by other known attachment methods that will serve to resist rotation of the outside wall of flexible insert  276  inside lower section  256 . 
     Flexible insert  276  is preferably made from a cellular polymeric material having sufficient porosity or liquid-retaining capability to receive and hold liquid  274  flowing into cavity  262  from cavity  258  following displacement of closure  270 , and also having the ability to release or discharge liquid  274  onto an attachment surface of a fluid connector with which flexible insert  276  is placed in contact during use of cleaning tool  252 . As shown in  FIGS. 39 and 40 , flexible inert  276  preferably further comprises a cylindrical recess  278  that is configured to receive the attachment end of a fluid connector device for cleaning and/or disinfecting during use of tool  252 . Flexible insert can be held in place by a retainer ring  280  insertable into annular recess  268 , although the use of such a retainer ring is not required if flexible insert  276  is attached to the inside of lower section  256  as previously described. Although not shown in  FIG. 29 , it will be appreciated that a seal or cover as previously described in relation to cover  206  of  FIGS. 32-34 ,  36  is desirably applied across the open end of lower section  256  following assembly of tool  252  as described above. Such a seal or cover will maintain the open end of tool  252  in a sanitary condition until removed just prior to use, and can be conveniently attached by pressure-sensitive adhesive or the like to the underside of flange  266 . Where tool  252  is entirely packaged inside a sanitary wrap, the use of another seal or cover across the opening of lower section  256  is not needed. 
     To use cleaning tool  252 , following removal of the sanitary wrap or cover, the free end of the fluid connector device having the attachment surfaces to be cleaned is desirably inserted into recess  278  of flexible insert  276 , and is forced upwardly, causing the upper surface of flexible insert  276  to contact prongs  272  of closure  270 , best seen in  FIGS. 38 and 41 . The continued application of upwardly directed force to the fluid connector will displace closure  270 , thereby releasing cleaning and/or disinfecting fluid  274  downwardly into flexible insert  276 . The configuration of prongs  272  and the material used to make them are desirably such that they will transmit to the body of closure  270  enough force to displace closure  270  from the opening defined by annular collar  264 . Alternatively, closure  284  having a single projection  286  with a slightly stepped-in diameter relative to body  288  can be substituted for closure  270  if desired. 
     Referring to  FIGS. 44-47 , another cleaning tool  300  is disclosed that is made similarly to tool  252  of  FIGS. 37-42 , but utilizes a stopper  314  made as shown in  FIG. 43 . Tool  300  comprises housing  302  with upper section  304  having a closed end  306 , and a lower section  308  having annular flange  310  at its base, and an annular recess  324  inside flange  310 . In this embodiment, flexible insert  320  is made as shown in  FIG. 47 , with a larger-diameter base  338  and a transverse slit  322  extending upwardly into, but not through the top of body section  340 . Referring to  FIG. 46 , when flexible insert  320  is made with a slit  322  instead of a recess  278  as shown in  FIG. 39 , attachment surfaces such as threads  336  of fluid connector  328 , here attached to a fluid flow line  334 , can be forced upwardly into slit  322 , causing top surface  332  to contact and displace closure  314 . This in turn allows cleaning and/or disinfecting liquid  316  as previously described to flow downwardly as indicated by arrows  330  to saturate flexible insert  320 . Attachment surfaces  336  of fluid connector  328  are then cleaned by moving tool  300  both axially and rotationally in relation to fluid connector  328 . 
     Referring to  FIG. 48 , cleaning tool  350  is another embodiment of the invention wherein a flexible insert  362  made as described in relation to  FIGS. 44-47 . In this embodiment, housing  352  has substantially parallel inside and outside walls that continue from flange  356  to closed end  354  of the upper cavity. Annular collar  358  is desirably made substantially as described in relation to  FIG. 42  to facilitate insertion and removal of a core pin in the molding tool (not shown) and to facilitate installation and displacement of closure  360 . In this embodiment, fluid  364  must again have sufficient headspace to allow displacement of closure  360 . However, where closure  360  is a membrane that is ruptured, torn or perforated, little if any headspace is required. 
     Referring to  FIGS. 49-54 , another cleaning tool  400  is disclosed that comprises housing  402  having one closed end  424  and an oppositely disposed open end with a fluted, substantially cylindrical, sidewall  404  disposed therebetween, the sidewall  404  further comprising a larger diameter annular sidewall section  406  defining an annular recess  420  and an annular flange  410  with substantially flat annular sealing surface  412  disposed adjacent to the open end. A first flexible polymeric foam insert  414  capable of absorbing and subsequently expelling liquid cleaner is desirably anchored inside housing  402  in such manner that insert  414  cannot be rotated freely inside housing  402  during use. An opening such as slit  416  is preferably provided in the end of insert  414  that faces outwardly from housing  402 . A second flexible foam insert  418  having a diameter slightly larger than that of insert  414  and a thickness such that insert  418  can be received inside annular recess  420  when compressed is preferably attached to the underside of flexible, fluid impermeable web  408  in a position aligned with annular recess  420  of housing  402 . Web  408  serves as a removable closure or cover for cleaning tool  400  after a liquid suitable for cleaning and/or disinfectant use for medical devices has been introduced into housing  402 , where the liquid is absorbed into foamed inserts  414  and  418 . Web  408  is desirably releasably attached to flange surface  412  of housing  402  by a releasable adhesive that provides a satisfactory liquid-tight seal between housing  402  and web  408 . If desired, a label or other printed indicia can be applied to the outwardly facing surface of web  408 , said surface being shown in  FIG. 54 . Upon removal of web  408  just prior to use, the liquid-containing disk-shaped insert  418  attached to the underside of the web can be used for topical cleaning of skin, an exposed surface of an object, or an attachment surface of a fluid connector as desired in addition to use of the liquid-containing flexible insert  414  disposed inside the housing. 
     Referring to  FIGS. 55-59 , another cleaning tool  500  is disclosed that can be used for both topical cleaning of skin or an exposed surface, and for mechanically cleaning and/or applying fluid to attachment surfaces of fluid connector devices used in medical applications. Cleaning tool  500  preferably comprises structural elements substantially as described in Paragraph 0041 above, including housing  502  with closed end  504 , annular sidewall section  506  defining annular recess  520 , annular flange  510  with annular sealing surface  512 , and flexible, fluid-tight closure  508 . The outside diameter of flange  510  is desirably sufficient great to shield insert  514  from direct contact with the fingers of the user, but not so great as to create interference with branched structures that are part of the device to be cleaned. Cleaning tool  500  differs from cleaning tool  400  discussed above in that tool  500  preferably comprises only a single, liquid-absorbing, flexible, compressible foamed polymeric insert  514  having a cylindrical base  530 , bottom  534 , sidewall  528 , and a top surface  532  that preferably comprises recess  516 . Cylindrical base  530  of insert  514  is preferably heat-staked inside of, or otherwise attached in fixed relation to, annular recess  520  of housing  502 . Recess  516  in upwardly projecting portion of insert  516  is desirably provided to facilitate use as a cleaning tool for attachment surfaces of fluid connector devices used in medical applications. Prior to heat-staking insert  514  in place relative to housing  502 , a cleaning and/or disinfecting liquid  536  is desirably introduced into the interior space of the housing. Prior to sealing with web closure  508 , insert projects upwardly past the otherwise open end of the housing substantially as shown in  FIG. 59 , except that the level of cleaning liquid  536  is typically as shown in  FIG. 58  prior to saturating insert  514 . Referring to  FIG. 58  after attachment of insert  514  to annular recess  520  of housing  502 , the flexible foam insert is desirably compressed inside the housing and web  508  is releasably sealed to sealing surface  512  ( FIG. 59 ) of flange  510  to cover the opening and maintain insert  514  in its compressed state pending use. When web closure  508  is later removed just prior to use, and the insert is substantially saturated with the cleaning liquid, as it will typically be during shipment and handling prior to use, insert  514  expands again to its projecting position to facilitate use as a topical cleaning or disinfecting tool. Recess  516  in the upwardly facing portion of insert  514  can receive at least a portion of the attachment surfaces of a fluid connector or such other device to be cleaned, and the upwardly projecting portion of insert  514  can be forced back down inside housing  502 , where sidewalls  504  provide resistance and facilitate scrubbing the attachment surfaces. Recess  516  can be formed by melting or burning a hole into insert  514  or another similarly effective means such as drilling. Also, a rod can be pressed upwardly from the bottom of insert  514  prior to attachment to housing  502 , and a cone or cylinder of the foamed material will project upwardly from surface  532  ( FIG. 57 ) and can be clipped away. When the rod is removed, a recess  516  will thereby be formed that is visible and accessible in and below surface  532 . 
     It will be apparent to those of ordinary skill in the art upon reading this disclosure that the protruding insert  514  facilitates use of cleaning tool  500  as a skin-prep tool as well as for cleaning attachment surfaces of a device. Because insert  514  is anchored inside housing  502 , rotation of insert  514  inside housing  502  is limited, and frictional contact between insert  514  and an attachment surface is enhanced. Furthermore, recess  516  serves as guide for the insertion of a fluid connector into tool  500  for cleaning. Tool  500  serves well for cleaning external threads of a fluid connector or other device, and flange  510  shields the user&#39;s fingers from contacting and possibly contaminating either insert  514  or the attachment surfaces being cleaned. The open space in housing  502  below annular recess  520  allows insert  514  to be compressed sufficiently inside housing  502  to produce a substantially flat seal by web  508 , and also allows for variable compression inside housing  502  during use. Referring to  FIGS. 55-57 , web closure  508  can optionally include an outwardly facing label  526  having desired indicia printed on it. Web closure  508  preferably comprises at least one portion extending outwardly beyond flange  510  that is manually graspable to facilitate removal from housing  502  prior to use. 
     The absence of lateral support above recess  520  and flange  510  makes it easier to push insert  514  inside housing  502  prior to sealing, and also facilitates disengagement and removal of a cleaned device following use because the device can pull insert  514  back outside housing  502 , again relieving the lateral support that may otherwise be holding the walls of recess  516  against threads or other attachment surfaces of the device. More available space within housing  502  also allows the use of more cleaning liquid during assembly. 
     It will be appreciated that the cleaning tools of the invention are desirably packaged and sterilized so that they will remain sterile until removed from the packages immediately prior to use. Desirably, where the cleaning tool is shipped and stored with a flexible insert that is already at least partially saturated with a cleaning and disinfecting fluid, a barrier material should be used as part of the packaging treatment to further insure that the fluid does not evaporate prior to use. 
     Referring to  FIGS. 60-69 , according to at least one embodiment of the invention, a cleaning tool  600  for medical devices is disclosed that comprises a substantially cylindrical housing  602  having an open end  614 , a closed end  606 , and a sidewall  604  disposed between the open end and closed end. As used in connection with this embodiment of housing  602  of the invention, “substantially cylindrical” means that the overall configuration of sidewall  604  is generally cylindrical and that open end  614  and closed end  606  are generally circular, although they can have different inside diameters if, for example, sidewall  604  tapers slightly inwards toward closed end  606 . It will be appreciated upon reading this disclosure that sidewall  604  can have, for example, a plurality of spaced-apart ribs  608  and a stepped inside diameter  618 , which can include an annular shoulder or recess inside housing  602 . Housing  602  is preferably made of a moldable or thermoformable polymeric material, and the thickness and rigidity of sidewall  604  are desirably such that housing  602  can be grasped and manipulated by a user, with some accompanying flexure occurring in sidewall  604  as cleaning tool  600  is used for an intended purpose. 
     Referring particularly to  FIGS. 60-63 , sponge  628 , also preferably substantially cylindrical, and a treating liquid  640  are desirably disposed inside housing  602 . Positioning collar  620  is desirably configured to receive and constrain sponge  628  as shown in  FIG. 62 , and to be inserted into and seated inside housing  602  between open end  614  and closed end  606 . FIGS.  63  and  66 - 69  show positioning collar  620  seated inside housing  602 . Positioning collar  620  desirably comprises a narrow, radially extending gap  622 , most preferably beveled adjacent outside edge  624 , that is sufficiently wide to facilitate insertion of a constricted section of sponge  628  into aperture  626  to the position shown in  FIG. 62  before positioning collar  620  and sponge  628  are seated inside housing  602 . Positioning collar  602  is also desirably molded from a suitable moldable polymeric resin. 
     Positioning collar  620  is preferably seated transversely to a longitudinal axis of housing  602  and substantially parallel to open and closed ends  614 ,  606 , respectively. Referring to  FIGS. 61 and 63 , positioning collar  620  can be seated inside sidewall  604  of housing  602  by any suitable means and method that are capable of producing and maintaining acceptable alignment of positioning collar  620  inside housing  602 . As shown in  FIGS. 61 and 63 , such acceptable alignment is achieved by pushing positioning collar  620  past circumferentially spaced apart, inwardly facing projections  616 , and thereby causing positioning collar  620  to be seated between projections  616  and an annular shoulder produced by inward step  618  in the inside diameter of sidewall  604  of housing  602 . When positioning collar  620  is seated inside housing  602  as described above, positioning collar  620  also releasably constrains sponge  628  inside housing  602 . In at least a portion of the interior sections of housing  602  that are disposed ahead of and behind the seated positioning collar  620  (or above and below it, depending upon how the subject cleaning tool is oriented), sponge  628  will desirably expand approximately to the full inside diameter of the housing as shown in  FIG. 63 . This is particularly true for those portions of sponge  620  that are closest, respectively, to the two ends of housing  602 . Portions of sponge  628  disposed nearer to positioning collar  620  can, however, remain more constricted prior to use of cleaning tool  600  for its intended purpose. 
     The inside diameter of positioning collar  620  at the edge of aperture  626  is desirably slightly greater than the largest transverse dimension of that part of the medical device  644  that is to be cleaned using cleaning tool  600  of this embodiment of the invention. After sponge  628  (or any other similarly effective and suitable porous, liquid absorbing, flexible insert) and positioning collar  620  are seated inside housing  602 , housing  602  can be partially filled with sufficient liquid treating chemical  640  (visible in  FIG. 63 ) to substantially saturate sponge  628  prior to use (as shown in  FIG. 66 ). A manually releasable, fluid-tight cover seal  610 , as shown in  FIGS. 60 ,  61 ,  64  and  65 , is then applied over the open end of the housing to cover the opening and seal the cleaning liquid inside the tool. Fluid-tight cover seal  610  desirably provides fluid-tight engagement between seal  610  and annular flange  612  (seen in  FIG. 61 ) of housing  602 , and preferably further comprises an elongated tab  636  that is useful when peeling seal  610  away from housing  602  as shown by arrow  638  in  FIG. 64  prior to use of cleaning tool  600 . Fluid-tight cover seal  610  is desirably made of a material that is sufficiently impermeable to the passage of liquid through it that treating liquid  640 , seen in  FIG. 63 , will not evaporate during storage or shipping prior to use when cleaning tool  600  is subjected to its normally anticipated shelf life and conditions of storage. 
     It will be appreciated by those of ordinary skill in the art upon reading this disclosure that fluid-tight cover seal  610  can be applied to flange  612  of housing  602  using any suitable, commercially available material or technology as disclosed above in relations to other embodiments of cleaning tools of the invention or as otherwise known in the prior art, and that treating liquid  640  can likewise be any suitable cleaning or disinfecting agent, or other suitable liquid known and available to those of ordinary skill in the art for use for the intended purpose of cleaning attachment surfaces of medical devices such as attachment surfaces  645 ,  646 ,  648  of fluid connector  644  as seen in  FIGS. 66-69 . 
     During use of this embodiment of the invention, cleaning tool  600  is desirably inverted prior to removing cover seal  610  so that treating liquid  640  can flow into and saturate sponge  628  as indicated by arrows  642  of  FIG. 66 . When seal  610  is peeled back and removed from cleaning tool  600  by pulling tab  636  (as seen in  FIG. 64 ), the forwardly extending tip of a medical device  644  to be cleaned is desirably inserted into housing  628  with forwardly extending tip  645  of device  644  abutting against outwardly facing surface  632  ( FIG. 61 ) of sponge  628 , as shown by arrow  650  of  FIG. 66 . As forwardly extending tip  645  of device  644  approaches positioning collar  620 , sponge  628  partially collapses around threads  648  and other attachment surfaces  646  of medical device  644  to be cleaned. Cleaning of front tip  645 , attachment surfaces  646  and threads  648  can be further enhanced by rotating housing  602  relative to device  644  as indicated by arrow  652  of  FIG. 67 . As tip  645  of device  644  is forced through aperture  626  ( FIG. 61 ) of positioning collar  620 , sponge  628  is further squeezed around attachment surfaces  645 ,  646  and threads  648  of device  644 . Referring next to FIG.  68 , further movement of front tip  645  into housing  602  as indicated by arrow  654  desirably causes sponge  628  to pass through the aperture positioning collar  620  into a position behind collar  620  where sponge  628  is no longer diametrically constrained by positioning collar  620 . Referring to  FIG. 69 , upon withdrawal of cleaned device  644  from cleaning tool  600  as indicated by arrow  656 , sponge  628  is largely or totally retained inside the end of housing  602  adjacent closed end  606  ( FIG. 61 ) by positioning collar  620 , which desirably remains seated inside housing  602 , thereby preventing any further contamination by possible contact between the “dirty” sponge  628  and tip  645  or the hands of the user. 
     Other alterations and modifications of the invention disclosed herein will likewise become apparent to those of ordinary skill in the art upon reading this disclosure, and it is intended that the scope of the invention be limited only by the broadest interpretation of the appended claims to which the inventors are legally entitled.