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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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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.
information intended for the addressee named above.
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Adventist Hospital.
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Hi Jayne
I recall an anecdotal report of a patient with a chlorhexidine allergy who had a chlorhexidine containing wipe used prior to venepunture and suffered anaphylaxis. The swab used did not clearly identify chlorhexidine content and looked like a alcohol only swab, apparently. Not sure if this incident was every documented publicly.
This clearly highlights the dangers of chlorhexidine, but anaphylaxis due to chlorhexidine is rare, and the potential for blood-stream infection is much higher. It would be appropriate to ensure all chlorhexidine containing swabs and solutions are clearly unidentified as containing chlorhexidine, and that there is a process (similar to latex allergy I would suggest) of identifying patients with chlorhexidine allergy and managing them appropriately.
I would not support a blanket ban of chlorhexidine containing products in line management, given the good evidence of their efficacy in reducing blood-stream infection risks associated with intravascular lines.
You also may want to consider an audit of line management which includes the appropriate drying of solutions used prior to manipulating lines.
Cheers
Michael Wishart
Infection Control ProfessionalMichael Wishart
Public Health Nurse,Communicable Disease Control
Logan West Moreton PHU
Ph 34131200 Fax 34131221To contact Nursing team:
LWM_PHN@health.qld.gov.au>>> Jayne OConnor 24/05/2012 4:15 pm >>>
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.Tel: (02) 9487 9433
Mobile: 0406 752 685
Email: jayne.oconnor@sah.org.auCAUTION: This message may contain both confidential and privileged information intended for the addressee named above.
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by Sydney Adventist Hospital to state that they are the views of Sydney Adventist Hospital.
_____________________________________________________________________
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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
[cid:815383006@24052012-2F04][cid:815383006@24052012-2F0B]
________________________________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.If you are not the intended recipient you are hereby notified that any dissemination, distribution or reproduction of this message
is prohibited. If you have received this message in error please notify the sender immediately, then destroy the original message.
Any views expressed in this message are solely those of the individual sender, except where the sender is specifically authorised
by Sydney Adventist Hospital to state that they are the views of Sydney Adventist Hospital.
_____________________________________________________________________
This e-mail has been scanned for viruses by Symantec Hosted Services
Scanning Services – powered by MessageLabs. For further information
visit http://www.messagelabs.com_____________________________________________________________________
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Sydney & South Western Sydney Local Health Districts regularly monitor email and attachments to ensure compliance with the NSW Ministry of Health’s Electronic Messaging Policy.
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________________________________
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