Course Access
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
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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
________________________________
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
________________________________
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
________________________________
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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