skin prep for haemodyalisis – question

[Ryan, Lindy]

Hello

We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .

Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.

I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis …just wondering if anyone out there was using anything else in these pts with success …or is sterile normal saline the only best option to stick with ?

Many thanks

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and humane management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

________________________________

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[Tim Spencer]

Hi Lindy,
Sterile saline is just that – sterile saline!
It has no antiseptic properties at all and so I would not recommend cleaning the site with saline prior to cannulation. There is still potential to drag skin colonies into the fistula during the cannulation process.

If anything, I would suggest the use of plain isopropyl alcohol (70%) as at least that will kill bacteria on the skins surface.
CHG & PI merely provide a longer acting antiseptic phase once on the skin.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant

Sent from my iPhone

> On Dec 8, 2016, at 17:20, Lindy Ryan wrote:
>
> Hello
>
> We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .
>
> Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.
>
> I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?
>
> Many thanks
>
> Kind regards
>
> Lindy
>
> Lindy Ryan
>
> Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
> Pacific Hwy Coffs Harbour NSW 2450
> Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
> http://www.health.nsw.gov.au
>
>
>
>
> Wise and humane management of the patient is the best safeguard against infection
> (Florence Nightingale Circa 1860)
>
>
>
>
>
> This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
> 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.
>
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[Carolyn.Chenoweth@FMC-ASIA.COM Subject: Re: skin prep for haemodyalisis – question In-Reply-To:]

Hi Lindy,

See below for haemodialysis access cleansing
that we recommend for patients in our dialysis clinics across Australia
and Asia Pacific.

1. Educate patients to wash their fistula
with normal liquid hand soap (we do not use antimicrobial hand soap) at
dedicated clinical hand basins (no liquids e.g. dialysate emptied into
these sinks) on arrival.

If patients have mobility issues and
can’t access the clinical hand basins we offer alcohol based hand rubs
to clean their hands and fistula.

2. We recommend Chlorhexidine (0.5%
to 2%) combined with alcohol, swabs for all skin cleansing prior to cannulation.

2% chlorhexidine can cause skin irritation
while rarely have issues with 0.5% or 1%chlorhexidine and alcohol.

If chlorhexidine can’t be tolerated
at all we either use povidine iodine or plain alcohol swabs.

The very rare patients who are highly
sensitive to everything we just ensure very good hand washing and washing
fistula with liquid hand soap.

With best regards
Carolyn Chenoweth
Quality & Infection Prevention and Control Manager, Australia
Asia Pacific Quality & IPC SME. CICP

Fresenius Medical Care Australia Pty Ltd
Payneham Dialysis Clinic,
2 Portrush Road
PAYNEHAM 5070
Australia
T: +61 (0) 8 8165 4313
M: +61 (0) 407 810 800
http://www.fmc-ag.com

From:      
 "EXTERN ACIPC
Infexion Connexion" <AICALIST@AICALIST.ORG.AU>

To:      
 AICALIST@AICALIST.ORG.AU

Date:      
 09/12/2016 07:59 AM

Subject:    
   skin prep for
haemodyalisis – question

---

Hello

 

We have a pt with sensitivity to povidine
/iodine and CHG who has a fistula & is having regular haemodialysis
.

 

Other than cleaning her skin with sterile
normal saline prior to cannulating them for their dialysis  is there
any  other skin antisepsis that could be used.

 

I have looked at referenced from CDC and
APIC but there is nothing  useful re any other skin antisepsis just
wondering if anyone out there was using anything else in these pts  with
success or is sterile normal saline the only best option  to stick
with ?

 

Many thanks

 

Kind regards

 

Lindy

 

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs
Harbour Health Campus

Pacific Hwy Coffs Harbour
NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au




 


Wise and humane management of the patient is the best safeguard against
infection

(Florence Nightingale Circa
 1860)

 

 

 

---

This message is intended for the addressee(s) named and may contain confidential
information. If you are not the intended recipient, please delete the message
and any attachments and notify the sender. Views expressed in this message
are those of the individual sender, and are not necessarily the views of
NSW Health or any of its entities.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF
THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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the list.

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j{M;Ov<

[Claire Rickard]

Hi Lindy, I agree with Tim & Carolyn, you could use 70% alcohol (and of
course let it dry :)). If this is going to be a regular patient, there is
another good agent (and generally well tolerated e.g. Used in
neonates) called octenidine which is used ++ in Europe but not currently
registered in Aust, u could get your pharmacist to get Special Access
Scheme approval from TGA and order from o/s.

Hope this helps, C

*Claire Rickard **RN PhD FAHMS FACN*
*Director, Alliance for Vascular Access Teaching and Research
(AVATAR), & **Professor, National
Centre of Research Excellence in Nursing Interventions, Menzies Health
Institute Queensland*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

On 9 December 2016 at 08:59, wrote:

> Hi Lindy,
> See below for haemodialysis access cleansing that we recommend for
> patients in our dialysis clinics across Australia and Asia Pacific.
>
> 1. Educate patients to wash their fistula with normal liquid hand soap (we
> do not use antimicrobial hand soap) at dedicated clinical hand basins (no
> liquids e.g. dialysate emptied into these sinks) on arrival.
> If patients have mobility issues and can’t access the clinical hand basins
> we offer alcohol based hand rubs to clean their hands and fistula.
>
> 2. We recommend Chlorhexidine (0.5% to 2%) combined with alcohol, swabs
> for all skin cleansing prior to cannulation.
> 2% chlorhexidine can cause skin irritation while rarely have issues with
> 0.5% or 1%chlorhexidine and alcohol.
> If chlorhexidine can’t be tolerated at all we either use povidine iodine
> or plain alcohol swabs.
> The very rare patients who are highly sensitive to everything we just
> ensure very good hand washing and washing fistula with liquid hand soap.
>
>
> With best regards
> * Carolyn Chenoweth*
> Quality & Infection Prevention and Control Manager, Australia
> Asia Pacific Quality & IPC SME. CICP
>
> Fresenius Medical Care Australia Pty Ltd
> Payneham Dialysis Clinic,
> 2 Portrush Road
> PAYNEHAM 5070
> Australia
> T: +61 (0) 8 8165 4313
> M: +61 (0) 407 810 800
> *www.fmc-ag.com*
>
>
>
>
>
> From: “EXTERN ACIPC Infexion Connexion”
> To: AICALIST@AICALIST.ORG.AU
> Date: 09/12/2016 07:59 AM
> Subject: skin prep for haemodyalisis – question
> ——————————
>
>
>
> Hello
>
> We have a pt with sensitivity to povidine /iodine and CHG who has a
> fistula & is having regular haemodialysis .
>
> Other than cleaning her skin with sterile normal saline prior to
> cannulating them for their dialysis is there any other skin antisepsis
> that could be used.
>
> I have looked at referenced from CDC and APIC but there is nothing useful
> re any other skin antisepsis just wondering if anyone out there was using
> anything else in these pts with success or is sterile normal saline the
> only best option to stick with ?
>
> Many thanks
>
> Kind regards
>
> Lindy
>
> *Lindy Ryan*
>
> Infection prevention & Control Clinical Nurse Consultant (CNC) | *Coffs
> Harbour Health Campus*
> Pacific Hwy Coffs Harbour NSW 2450
> Tel (02) 6656 7770 | *lindy.ryan@ncahs.health.nsw.gov.au*
>
> *www.health.nsw.gov.au*
>
>
>
>
> Wise and humane management of the patient is the best safeguard against
> infection
> (Florence Nightingale Circa 1860)
>
>
>
>
>
> ——————————
>
> This message is intended for the addressee(s) named and may contain
> confidential information. If you are not the intended recipient, please
> delete the message and any attachments and notify the sender. Views
> expressed in this message are those of the individual sender, and are not
> necessarily the views of NSW Health or any of its entities.
> 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*
>
> 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
>
>

—

*Claire Rickard **RN PhD FAHMS FACN*
*Director, Alliance for Vascular Access Teaching and Research
(AVATAR), & **Professor, National
Centre of Research Excellence in Nursing Interventions, Menzies Health
Institute Queensland*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

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.

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[Cath Murphy]

Hi Lindy
In addition to my earlier comments I just wanted to add some info about alcohol that may have been overlooked and which may be worth consideration.

Alcohols mechanism of action is by disrupting cell membrane. It has excellent effect against both gram -ve & gram +ve orgs and has excellent rapidity of action. It has no persistence or residual action. Optimum concentrations are 60%-90% and it does not penetrate organic material.

Cheers
Cath

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Friday, 9 December 2016 7:36 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: skin prep for haemodyalisis – question

Hi Lindy,
Sterile saline is just that – sterile saline!
It has no antiseptic properties at all and so I would not recommend cleaning the site with saline prior to cannulation. There is still potential to drag skin colonies into the fistula during the cannulation process.

If anything, I would suggest the use of plain isopropyl alcohol (70%) as at least that will kill bacteria on the skins surface.
CHG & PI merely provide a longer acting antiseptic phase once on the skin.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Vascular Access Consultant

Sent from my iPhone

On Dec 8, 2016, at 17:20, Lindy Ryan <Lindy.Ryan@NCAHS.HEALTH.NSW.GOV.AU> wrote:
Hello

We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .

Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.

I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?

Many thanks

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

Wise and humane management of the patient is the best safeguard against infection
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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.

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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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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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