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Dear Chris,
Dr Matthias Maiwald posted a very comprehensive response in relation to a very similar query on the list Thursday last week which you may wish to access from the archives. I have pasted a paragraph from Dr Maiwalds post for your information:
But please bear in mind that the addition of chlorhexidine to the alcohol for swabbing the vial tops is absolutely unnecessary. The chlorhexidine adds next to nothing for the purpose of disinfecting vial tops, and pure alcohol (e.g. 70% isopropanol such in sterile prepackaged alcohol pads) is all that is needed. What the chlorhexine would add would be persistency, which is an advantage for skin antisepsis for longer procedures, but you don’t need persistent antiseptic action on vial tops.
Chlorhexidine gluconate kills a range of Gram positive and Gram negative bacteria, viruses and fungi, and binds to the top layer of the skin, which results in persistent activity. Persistence of the antimicrobial effect suppresses the regrowth of residual skin flora, as well as suppressing transient micro-organisms contacting the prepped site. Alcohol has a rapid effect but no residual effect. If you would like further information regarding appropriate uses for chlorhexidine gluconate, please refer to the CHRISP website.
The TGA recommends wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. Queensland Health recommend the suitable disinfectant for this purpose is a 70% alcohol impregnated swab.
Please find a copy of the related poster attached to this reply.
Kind regards,
KathCHRISP, Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 1, 15 Butterfield St, Herston, QLD 4006
PO Box 2368, Fortitude Valley, QLD 4006
t. 07 33289755
e. chrisp@health.qld.gov.au | http://www.health.qld.gov.au
[cid:image001.png@01CFC2AF.19BA7870] [cid:image002.png@01CFC2AF.19BA7870] [cid:image003.png@01CFC2AF.19BA7870]
[cid:image004.png@01CFC2AF.19BA7870]——– Original Message ——–
Subject: FWD: 'Wipe the stopper' poster
From: Michael Wishart <michael.wishart@internode.on.net>
To: AICALIST@AICALIST.ORG.AU
CC:[Posted on behalf of Chris Lawson – Moderator]
Hi,Following the release of the below we have had some suggestion that only alcohol swabs should be available for use. that we should remove chlorhexidine swabs altogether from practice. Can I have some feedback fro the group please.
Regards
Chris Lawson
Caboolture Private HospitalSent from my iPad
Begin forwarded message:
Subject: ‘Wipe the stopper’ poster
Dear All
On 7 July 2014 the Therapeutic Goods Administration (TGA) updated their website to include details of the ongoing investigation into the potential contamination with Ralstonia species of some vials of propofol 1% emulsions for injection. This website update included the advice that the exterior surfaces of injection vials are not intended to be sterile and that health professionals are reminded that proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm
CHRISP have developed the attached poster to assist facilities to educate clinicians that the rubber stopper of vials under the plastic flip lid is not intended to be sterile and should be wiped with a 70% alcohol impregnated swab and allowed to dry prior to accessing. This will also be published on the CHRISP website in the near future: http://www.health.qld.gov.au/chrisp/default.asp
Please disseminate to other areas of your facility as appropriate.
Kind regards, Mareeka Gray
CHRISP
(Centre for Healthcare Related Infection Surveillance and Prevention)
Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 3, 15 Butterfield St, Herston QLD 4006
PO Box 2368, Fortitude Valley, QLD, 4006
t. 07 33289755
e. CHRISP_TB@health.qld.gov.au | http://www.health.qld.gov.au********************************************************************************
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Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
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**********************************************************************************MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Kath
While acknowledging that the addition of Chlorhexidine to alcohol adds no additional benefit for the purpose of vial disinfection, having access to both combination Chlorhexidine and alcohol impregnated swabs and plain alcohol swabs increases the risk of inappropriate skin antisepsis. It is for this reason that we have removed plain alcohol based swabs completed and only stock Chlorhexidine and alcohol swabs. This does have a cost implication but on balance for considered to be insignificant compared to the risk associated with line-associated sepsis.
Regards
BethBeth Bint
Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________Dear Chris,
Dr Matthias Maiwald posted a very comprehensive response in relation to a very similar query on the list Thursday last week which you may wish to access from the archives. I have pasted a paragraph from Dr Maiwalds post for your information:
But please bear in mind that the addition of chlorhexidine to the alcohol for swabbing the vial tops is absolutely unnecessary. The chlorhexidine adds next to nothing for the purpose of disinfecting vial tops, and pure alcohol (e.g. 70% isopropanol such in sterile prepackaged alcohol pads) is all that is needed. What the chlorhexine would add would be persistency, which is an advantage for skin antisepsis for longer procedures, but you don’t need persistent antiseptic action on vial tops.
Chlorhexidine gluconate kills a range of Gram positive and Gram negative bacteria, viruses and fungi, and binds to the top layer of the skin, which results in persistent activity. Persistence of the antimicrobial effect suppresses the regrowth of residual skin flora, as well as suppressing transient micro-organisms contacting the prepped site. Alcohol has a rapid effect but no residual effect. If you would like further information regarding appropriate uses for chlorhexidine gluconate, please refer to the CHRISP website.
The TGA recommends wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. Queensland Health recommend the suitable disinfectant for this purpose is a 70% alcohol impregnated swab.
Please find a copy of the related poster attached to this reply.
Kind regards,
KathCHRISP, Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 1, 15 Butterfield St, Herston, QLD 4006
PO Box 2368, Fortitude Valley, QLD 4006
t. 07 33289755
e. chrisp@health.qld.gov.au | http://www.health.qld.gov.au
[cid:image001.png@01CFC2AF.19BA7870] [cid:image002.png@01CFC2AF.19BA7870] [cid:image003.png@01CFC2AF.19BA7870]
[cid:image004.png@01CFC2AF.19BA7870]——– Original Message ——–
CC:[Posted on behalf of Chris Lawson – Moderator]
Hi,Following the release of the below we have had some suggestion that only alcohol swabs should be available for use. that we should remove chlorhexidine swabs altogether from practice. Can I have some feedback fro the group please.
Regards
Chris Lawson
Caboolture Private HospitalSent from my iPad
Begin forwarded message:
Dear All
On 7 July 2014 the Therapeutic Goods Administration (TGA) updated their website to include details of the ongoing investigation into the potential contamination with Ralstonia species of some vials of propofol 1% emulsions for injection. This website update included the advice that the exterior surfaces of injection vials are not intended to be sterile and that health professionals are reminded that proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm
CHRISP have developed the attached poster to assist facilities to educate clinicians that the rubber stopper of vials under the plastic flip lid is not intended to be sterile and should be wiped with a 70% alcohol impregnated swab and allowed to dry prior to accessing. This will also be published on the CHRISP website in the near future: http://www.health.qld.gov.au/chrisp/default.asp
Please disseminate to other areas of your facility as appropriate.
Kind regards, Mareeka Gray
CHRISP
(Centre for Healthcare Related Infection Surveillance and Prevention)
Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 3, 15 Butterfield St, Herston QLD 4006
PO Box 2368, Fortitude Valley, QLD, 4006
t. 07 33289755
e. CHRISP_TB@health.qld.gov.au | http://www.health.qld.gov.au********************************************************************************
This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.
Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.
Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.
Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.
**********************************************************************************
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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