Course Access
Dear Yuk Yin,
The chlorhexidine-alcohol combination would seem a good choice for peripheral IV line insertion, because the main thing that chlorhexidine adds to the mix is persistency on skin, which is a benefit for anything that stays in place for a while. On the other hand, applications that do not require persistency (such as one-time venipuncture, ports access, etc.) do well with just alcohol. As has been discussed (I believe here on this forum?), it may make sense in terms of handling IV devices if a unit uses chlorhexidine-alcohol also for port access — in terms of streamlining procedures — because then staff handling IV devices have to remember only one type of antiseptic and it is less complicated.
Injections, venipuncture and blood culture bottle diaphragm disinfection will do well with just alcohol; no chlorhexidine required.
A while ago (I think early 2013) there has been a public hearing by the US FDA if skin antiseptics should generally manufactured to the level of being sterile. For simple alcohol pads (as you mention), this is apparently an easy process, but for more complex skin antiseptics, the manufacturing process (to the formal level of “sterile”) apparently becomes quite cumbersome and more expensive. I can’t quite remember what the outcome was, but several people who have exellent knowledge in the area told me that this is not necessary if the manufacturer ensures in the manufacturing process that bacterial spores are excluded/avoided during manufacturing, and has quality processes in place to monitor this. The reason is that alcohol is basically “autosterile” except for bacterial spores. If that can be verified with a manufacturer, then I think it would be safe to use chlorhexidine-alcohol.
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
Dear Matthias,
Thanks for your advice.
Sterile Alcohol wipe is common in my hospital for injection, venous puncture or IV ports access. Recently, we review and consider to introduce wipe of 2% chlorhexidine and 70% v/v isopropyl alcohol for IV peripheral line insertion. We found that the products available in the market is not sterile because chlorhexidine cannot undergo sterilization. Since it is not “sterile”, I have hesitation if it can also be used to disinfect IV ports or diaphragm of blood culture bottles.
Regards,
Ho Yuk Yin, APN/ICN
Infection Control Unit,
Tung Wah Hospital
Dear Ms/Mr Ho,
It can be used, provided that:
(a) the alcohol is in a sufficient concentration (at least 70% v/v ethanol or isopropanol would be required), and
(b) the alcohol wipes have been manufactured in a way that this excludes bacterial spore contamination.
Please note that for the purposes you describe, i.e. (i) to disinfect injection ports, and (ii) the diaphragms of blood culture bottles, the alcohol is the important component, not the chlorhexidine. For both purposes, alcohol wipes/swabs alone without the chlorhexidine would be sufficient.
The reason why bacterial spores need to be excluded is that the alcohol does not kill spores (actually none of the common antiseptics kills spores, also chlorhexidine does not), and this has to be taken care of during the manufacturing process. It helps if the swabs/wipes are specifically labelled as “sterile”, otherwise you may want to contact the manufacturer for further information.
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
Dear All,
I wonder if antiseptic wipe ” alcohol based 2% Chlorhexidine” that indicated for skin disinfection can be used to disinfect injection ports or diaphragm of blood culture bottles. Please advise.
Regards,
Ho Yuk Yin, APN/ICN
Infection Control Unit
Tung Wah Hospital
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