Course Access
Hi Tim,
Alcohol-based products (in appropriate concentrations) are effectively “auto-sterile” except for bacterial spores. That is why they have to be filtered (a standard procedure) but not sterilised in a classical sense (such as autoclaving). For a product like the Solu IV sticks one would (I think) therefore have to postulate that the plastic sticks and swabs would have to be radiation-sterilised (a standard procedure for plasticware like syringes) and the CHG-ALC solution filtered separately and then combined under sterile conditions (although I am not familiar with the details of such pharmaceutical manufacturing processes). The problem with the SoluMed response was that they were not forthcoming with relevant information (e.g. whether above had been done) and the person that I corresponded with did not have the slightest clue about the underlying concepts of sterility.
I will have to dig in my old e-mails to find this.
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
Hi Matthias,
This has come up often about the fact that swabsticks are not “sterile”. I get asked about it alot.
The inability to heat treat for sterilisation with IPA is obviously a combustable issue. 😉
However, the sterilisation process also has some destabilisation of the CHG (from what I have heard only).
I am unawwre of ANY other product on the market at the moment that is completely sterilised for use (that contains CHG and IPA)
If you are happy, would you mind forwarding me the correspondence with SoluMed as I would like to also investigate this.
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 Intensive 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
[cid:963553402@15062012-1708][cid:963553402@15062012-170F]
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Dear Tim, dear Colleagues,
The use of 2% CHG with isopropanol versus 0.5 or 1% makes perfect biological and microbiological sense, but there are currently no data available from clinical trials (i.e. outcomes-based research) having compared the higher versus the lower concentration.
I wonder about the Solu IV swabsticks that are being mentioned. Earlier, in 2008, someone mentioned that they are not labelled as sterile. I looked into this a little further and contacted the Canadian headquarters, and they also stated that they are not sterile in a strict sense. It became obvious that the person from the headquarters who I was corresponding with had absolutely not the slightest clue about the concepts of sterility.
It is well known that alcohol products need to be filtered in the process of production, in order to exclude bacterial spores. This is a well-established standard process, and most companies just simply do it. A recent article in ICHE highlighted problems with alcohol pads where this apparently had not been done:
http://www.ncbi.nlm.nih.gov/pubmed/22669227
For items like the single-use swabsticks (soeaked with alcohol) that are packaged, I would assume (but I don’t know for certain) that the plastic sticks would have to be irradiated for sterility separately in the production process and the alcohol filtered (as stated above).
At the time, I ended up not following through with the correspondence (somewhat frustrated by the Canadian response), but I wonder if anyone from this list has looked at this issue (?).
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
Robert,
We have done so and do so for EVERY IV device, not just PIVs.
2% CHG in 70% IPA – its all evidence based and there is plenty of literature to support it as well.
We previously used 0.5% CHG in 70% IPA.
We use Solu-IV swabsticks (tinted for insertion and clear for maintenance) and the large wipes.
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 Intensive 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
[cid:075230600@15062012-16D7][cid:075230600@15062012-16DE]
________________________________
Good morning
I would like to know from those facilities who currently uses 70% Isopropyl alcohol v/v in 0.5% to 1% Chlorhexidine, and are moving towards or have now changed to using 2% Chlorhexidine in alcohol specifically for insertion of an Peripheral IVC.
I am aware of the current recommendations surrounding this but would like others comments on this matter.
regards
Robert Robinson
Clinical Nurse Consultant | Infection Control
Blacktown/Mt. Druitt Hospitals
Tel 02 9881 8994 | Mob 0408 923 789 | robert.robinson@swahs.health.nsw.gov.au
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