Course Access
In reply to general CHG comments so far;
CHG must be relatively safe for in vivo use, as it is impreganted into
many of our vascular devices (CVC and PICCs) commonly used these days –
there has only been relatively few isolated cases in Japan and the USA
from several years ago.
Matthias,
They might be fundamentally different things, but as a lead vascular
access nurse, I think compliance is more of the issue between healthcare
practitioners and their standard of care, than of two different types of
decontamination issues. I agree with you that 70% IPA is still widely
accepted and used for port decontamination, but current best practices
also recommends the use of CHG and IPA.
CDC Guidelines (2011) pp.19-20 recommend;
4. Minimize contamination risk by scrubbing the access port with an
appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or
70% alcohol) and accessing the port only with sterile devices [189, 192,
194-196]. Category IA
Although to monitor compliance more effectively CDC also recommend;
Use hospital-specific or collaborative-based performance improvement
initiatives in which multifaceted strategies are “bundled” together to
improve compliance with evidence-based recommended practices [15, 69,
70, 201-205]. Category IB
Regards,
T..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition
Service
Conjoint Lecturer, University of NSW
Dept of Critical Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
________________________________
Behalf Of Matthias Maiwald (KKH)
Dear Collagues,
Please bear in mind that (a) skin antisepsis before line insertion and
during maintenance and (b) antisepsis for access ports are two
fundamentally different things.
While the evidence for chlorhexidine plus alcohol for (a) appears solid
(although not quite as solid as commonly purported), there is much
weaker evidence for adding chlorhexidine to alcohol for (b).
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387
________________________________
Tim Spencer [Tim.Spencer@SSWAHS.NSW.GOV.AU]
Matt,
You are correct, though I would recommend 2% over 0.5% unless
allergy/sensitivity (as stated)
Most manufacturers are now only producing 2%CHG & IPA swabs/sticks.
I havent yet seen any mini ampules like the 0.5% CHG & IPA in 25ml.
🙂
T..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition
Service
Conjoint Lecturer, University of NSW
Dept of Critical Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
________________________________
Behalf Of Richards, Matthew
Tim
just a point of reference
The CDC 2011 guidelines recommendation for skin prep prior to the
insertion of a CVC is “>0.5% CHG with alcohol….if there is a
contraindication to CHG, tincture of iodine, an iodophor, or 70% alcohol
can be used as an alternative”. The reality is 2% CHG in 70% alcohol is
most commonly available and used.
The recommended CDC guidleiens for peripheral skin prep is with an
antiseptic “70% alcohol….or alcoholic CHG gluconate solution”
regards
Matthew Richards
Clinical Nurse Consultant
Infection Prevention and Surveillance Service
Melbourne Health
T: 9342 8325 F: 9342 8484
http://info2.mh.org.au/IPSS/NewWEB/default.htm
________________________________
Behalf Of Tim Spencer
cleaning protocol
Hi Jayne,
Currently, the CDC Guidelines, along with NICE (UK), SHEA (USA), INS
(USA) and AVA (USA), ESPEN (Europe) and IVNNZ (New Zealand) all
recommend 2% CHG with 70% IPA.
It’s is pretty much the worldwide standard for skin antisepsis prior to
inserion of a IV device (peripheral or central), as well as
hub/cap/valve decontamination on any IV device.
Never heard of it being injected into the patient! I would be interested
to see your ID physicians supportive evidence to show any accidental
injection of CHG & IPA into the patient and any detriments it may have.
The evidence speaks correctly. I would base your policy from
“evidence-based research and practices’, not speculation from various
individuals.
There is plenty of supportive literature.
Regards,
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition
Service
Conjoint Lecturer, University of NSW
Dept of Critical Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
________________________________
Behalf Of Jayne OConnor
Dear All,
We are currently revising our CVC policy and just wondering what
everyone used for cleaning the ports? All evidence points to 2%
Chlorhexidine in 70% alcohol, but we have had conflicting advice from
our ID physicians due to safety issues of injecting chlorhexidine into
lines?
Look forward to responses.
Kind Regards
Jayne
Jayne O’Connor RN, BSc.in Infection Control
Clinical Nurse Consultant- Infection Prevention & Control
Sydney Adventist Hospital,
185 Fox Valley Rd,.
Wahroonga,
NSW 2076.
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