Course Access
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Dear Fiona
You ask a good question.
We are a private Endoscopy Centre, so all our cannulas are peripherally inserted and insitu for <24hrs (usually in for 3 – 4.hrs max).
I saw the NSW Health published guideline called Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients too.
We discussed the very point you are looking at and looked at the ANTT guidelines and the EPIC2 guidelines and like yourself we are aware of IVC related BSIs occurring when the PIVC has been insitu for <24hrs.
We came to the conclusion that unless the patient had a chlorhexidine allergy/sensitivity we would continue to use the 2 %chlorhexidine 70%V/v Isopropyl alcohol solution (prep pad).(The cannula is being inserted into a blood vessel, I hesitate to ask …. how relevant is it, that it's only insitu for a limited amount of time? Aren't we wanting to ensure that skin antisepsis is carried out as per evidence based best practice prior to the cannula being inserted? The next question I want to ask is, if we only need to use 70% alcohol for skin antisepsis for PIVCs that are in situ for 70% alcohol solutions/swabs should be used (to reduce unnecessary exposure to chlorhexidine when residual antimicrobial activity is not required”
In the guideline appendix 5 it states that
“For a cannula that is likely to be in for <24hours, skin cleaning with at least 70% alcohol is sufficient"Our facility currently uses an alcoholic chlorhexidine skin prep for all PIVC insertions unless the person has a known sensitivity. We are currently reviewing this and are inclined to continue with this product as we have known of IVC related BSIs occurring when a PIVC has been insitu for less that the 24 hours outlined in this document.
We are interested to know what other facilities are using as skin prep for this cohort of patients.
Kind regards,Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076If you are not the intended recipient you are hereby notified that any dissemination, distribution or reproduction of this message
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Hi Teresa
Your question about which antiseptic to use for access site disinfection is an important one. There is really not much evidence around which antiseptic is better for this purpose, although logic suggests that alcohol alone would be just as effective as a combination of chlorhexidine and alcohol for this use. The rational for this would be looking at the instantaneous antimicrobial activity of alcohol, which is very good, and the utility of a residual effect with chlorhexidine in this use. Since the port/hub/ access site becomes closed (should!) immediately after use, residual effect should not be important here, unlike a skin site, which will always have some access for microbes whilst a cannula is in situ, so residual effect is important.
Another factor to consider is staff compliance with specific product use. If you provide both alcohol only and chlorhexidine and alcohol swabs, you run the risk of staff choosing one or the other for any purpose. If you only supply alcohol only for chlorhexidine sensitive patients, and supply chlorhexidine and alcohol for everything else, you are more likely to have chlorhexidine and alcohol use appropriately for skin antisepsis.
I am not aware of any reports of damage to ports/access sites/hubs from chlorhexidine, so I am not aware that is a factor in this discussion, but it is worthy checking with product manufacturers.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Dear Fiona
You ask a good question.
We are a private Endoscopy Centre, so all our cannulas are peripherally inserted and insitu for <24hrs (usually in for 3 – 4.hrs max).
I saw the NSW Health published guideline called Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients too.
We discussed the very point you are looking at and looked at the ANTT guidelines and the EPIC2 guidelines and like yourself we are aware of IVC related BSIs occurring when the PIVC has been insitu for <24hrs.
We came to the conclusion that unless the patient had a chlorhexidine allergy/sensitivity we would continue to use the 2 %chlorhexidine 70%V/v Isopropyl alcohol solution (prep pad).(The cannula is being inserted into a blood vessel, I hesitate to ask …. how relevant is it, that it's only insitu for a limited amount of time? Aren't we wanting to ensure that skin antisepsis is carried out as per evidence based best practice prior to the cannula being inserted? The next question I want to ask is, if we only need to use 70% alcohol for skin antisepsis for PIVCs that are in situ for 70% alcohol solutions/swabs should be used (to reduce unnecessary exposure to chlorhexidine when residual antimicrobial activity is not required”
In the guideline appendix 5 it states that
“For a cannula that is likely to be in for <24hours, skin cleaning with at least 70% alcohol is sufficient"Our facility currently uses an alcoholic chlorhexidine skin prep for all PIVC insertions unless the person has a known sensitivity. We are currently reviewing this and are inclined to continue with this product as we have known of IVC related BSIs occurring when a PIVC has been insitu for less that the 24 hours outlined in this document.
We are interested to know what other facilities are using as skin prep for this cohort of patients.
Kind regards,Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076If 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 Adventist HealthCare Limited to state that they are the views of Adventist HealthCare Limited.
_____________________________________________________________________
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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Thank you everyone for your on and off line responses.
Kind regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076Dear Fiona
You ask a good question.
We are a private Endoscopy Centre, so all our cannulas are peripherally inserted and insitu for <24hrs (usually in for 3 – 4.hrs max).
I saw the NSW Health published guideline called Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients too.
We discussed the very point you are looking at and looked at the ANTT guidelines and the EPIC2 guidelines and like yourself we are aware of IVC related BSIs occurring when the PIVC has been insitu for <24hrs.
We came to the conclusion that unless the patient had a chlorhexidine allergy/sensitivity we would continue to use the 2 %chlorhexidine 70%V/v Isopropyl alcohol solution (prep pad).(The cannula is being inserted into a blood vessel, I hesitate to ask …. how relevant is it, that it's only insitu for a limited amount of time? Aren't we wanting to ensure that skin antisepsis is carried out as per evidence based best practice prior to the cannula being inserted? The next question I want to ask is, if we only need to use 70% alcohol for skin antisepsis for PIVCs that are in situ for 70% alcohol solutions/swabs should be used (to reduce unnecessary exposure to chlorhexidine when residual antimicrobial activity is not required”
In the guideline appendix 5 it states that
“For a cannula that is likely to be in for <24hours, skin cleaning with at least 70% alcohol is sufficient"Our facility currently uses an alcoholic chlorhexidine skin prep for all PIVC insertions unless the person has a known sensitivity. We are currently reviewing this and are inclined to continue with this product as we have known of IVC related BSIs occurring when a PIVC has been insitu for less that the 24 hours outlined in this document.
We are interested to know what other facilities are using as skin prep for this cohort of patients.
Kind regards,Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076If 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 Adventist HealthCare Limited to state that they are the views of Adventist HealthCare Limited.
_____________________________________________________________________
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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 Adventist HealthCare Limited to state that they are the views of Adventist HealthCare Limited.
_____________________________________________________________________
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