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Dear Tim, dear Colleagues,
The use of 2% CHG with isopropanol versus 0.5 or 1% makes perfect biological and microbiological sense, but there are currently no data available from clinical trials (i.e. outcomes-based research) having compared the higher versus the lower concentration.
I wonder about the Solu IV swabsticks that are being mentioned. Earlier, in 2008, someone mentioned that they are not labelled as sterile. I looked into this a little further and contacted the Canadian headquarters, and they also stated that they are not sterile in a strict sense. It became obvious that the person from the headquarters who I was corresponding with had absolutely not the slightest clue about the concepts of sterility.
It is well known that alcohol products need to be filtered in the process of production, in order to exclude bacterial spores. This is a well-established standard process, and most companies just simply do it. A recent article in ICHE highlighted problems with alcohol pads where this apparently had not been done:
http://www.ncbi.nlm.nih.gov/pubmed/22669227
For items like the single-use swabsticks (soeaked with alcohol) that are packaged, I would assume (but I don’t know for certain) that the plastic sticks would have to be irradiated for sterility separately in the production process and the alcohol filtered (as stated above).
At the time, I ended up not following through with the correspondence (somewhat frustrated by the Canadian response), but I wonder if anyone from this list has looked at this issue (?).
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 1387Robert,
We have done so and do so for EVERY IV device, not just PIVs.
2% CHG in 70% IPA – its all evidence based and there is plenty of literature to support it as well.
We previously used 0.5% CHG in 70% IPA.
We use Solu-IV swabsticks (tinted for insertion and clear for maintenance) and the large wipes.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 Intensive 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:075230600@15062012-16D7][cid:075230600@15062012-16DE]________________________________
Good morning
I would like to know from those facilities who currently uses 70% Isopropyl alcohol v/v in 0.5% to 1% Chlorhexidine, and are moving towards or have now changed to using 2% Chlorhexidine in alcohol specifically for insertion of an Peripheral IVC.
I am aware of the current recommendations surrounding this but would like others comments on this matter.
regards
Robert RobinsonClinical Nurse Consultant | Infection Control
Blacktown/Mt. Druitt Hospitals
Tel 02 9881 8994 | Mob 0408 923 789 | robert.robinson@swahs.health.nsw.gov.au[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Western-Sydney-LHD.jpg]
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Dear Prue, dear Colleagues,
Just wanted to add one aspect to the discussion on alcohol-based surgical hand antisepsis: this is the importance of technique.
I realise there are differences between countries/settings where this is newly introduced versus those where this has been standard practice in operating theatres for many decades.
An example where this has been newly introduced and apparently failed due to non-adherence to proper technique is here:
http://www.ncbi.nlm.nih.gov/pubmed/20103542
In settings where this has been practiced for a long time such procedures become highly ritualised and are being watched by a number of (sometimes fierce) operating theatre nurses and surgeons, to make sure that every new person adheres to this.
A fundamental difference between simple ward-based hand antisepsis (such as for the 5 Moments) and surgical hand antisepsis is that for the former, a single volume of hand rub of about 3 mL is applied. For surgical hand antisepsis, the WHO 2009 Guideline recommends repeated application of about 15 mL to hands and forearms, but also states that one study demonstrated that keeping the hands and forearms literally wet with alcohol for the entire duration of the procedure is more important than the actual volume applied.
The latter would require re-thinking for those who are only used to the 5-Moments-type hand rub with about 3 mL, and is one reason why I do not recommend gels (but instead liquids) for surgical hand antisepsis — gels would just build up too much sludge when applied as required for surgical hand antisepsis.
As already mentioned, another article is here:
http://www.ncbi.nlm.nih.gov/pubmed/19716627
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 1387From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Prue Wright
Sent: Friday, 15 June, 2012 5:28 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrubHi All,
We have introduced Skinman which is an alcoholic based surgical scrub. It is very popular with the surgeons and scrub staff. Many of us have problems with dermatitis from traditional water based scrubbing, these have been resolved with the Skinman.Prue Wright
Infection Control Coordinator
Hurstville Private Hospital
37 Gloucester Rd, Hurstville, NSW 2220, Australia
T +61 2 9579 7780 F +61 2 9579 7466
E Infection.Control@hurstvilleprivate.com.au W healthecare.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tracy Sloane
Sent: Wednesday, 13 June 2012 9:19 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrubHi All,
If you check out the latest edition of Healthcare Infections you will find an article about a study I did prior to TGA approval of a surgical hand rub (SHR) looking at HCW current scrub practices and their knowledge and attitudes about SHR. You might find the reference list helpful.
Cheers,
Tracy
Tracy Sloane
Senior Infection Control Consultant
Dandenong Hospital, Southern Health
T (03) 95548173 F (03) 95541905
E tracy.sloane@southernhealth.org.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Helen Scott
Sent: Tuesday, 12 June 2012 2:36 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrubHi Jane,
The CDC have got a good article on this. It’s their MMWR and in October 2002, Vol 51, page 17 it discusses exactly this. I’m sure there’s a more up to date report somewhere. You could also try Skinman Soft, made by Orion.
Cheers,
Helen.Helen Scott
Infection Control Co-ordinator
Nepean Private Hospital
Penrith, NSW.
0247 327333
Helen.Scott@healthscope.com.auPlease consider the environment before printing this message
>>> On 11/06/2012 at 5:50 am, in message <5CF778CD399D414080027BBC8F4991D83567DA@mschcexp07.cdhb.local>, Jane Barnett <Jane.Barnett@CDHB.HEALTH.NZ> wrote:
Hi
Weve got some staff who can only use the PCMX scrub product as they are sensitive to both chlorhex and betadine but BD have advised that they are withdrawing this product. Can I ask what other centres are doing for staff with allergies would plain soap and water washed followed by plain alcohol (without antiseptic additive) be sufficient for surgical procedures? Thoughts/ideas welcome.
ThanksJane Barnett
Clinical Nurse Specialist
Infection Prevention & Control
Christchurch Women’s Hospital
Private Bag 4711, Christchurch
Tel: 03 364 4510 (int 85510)
Fax: 03 364 4607Infection Prevention and Control is Everyone’s Business
________________________________Attention:
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Dear Helen,
What kind of product do you mean? (a) Alcohol-based hand rub product or (b) soap-based hand wash product? (It would be either/or).
For (antiseptic) hand washing, a typical chlorhexidine concentration would be 4%, for alcohol-based hand or skin antiseptics, typical concentrations of chlorhexidine (if this is added) would be 0.5-2%.
For skin antisepsis, it is important to know whether it is (a) for normal superficial skin, or (b) for antisepsis on or near mucous membranes (e.g. vaginal surgery). For (b), alcohol-containing products cannot be used.
For normal superficial skin, chlorhexidine alone without alcohol or triclosan alone are not recommended, because they are too weak and ineffective as antiseptics.
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—–Original Message—–
[Posted on behalf of Helen Scott – Moderator]
We are installing a new alcohol based hand rub and soap product. The chlorhexidine hand wash at the sinks on the wards is going to be removed. We use this for skin antisepsis prior to aseptic techniques.
Are there guidelines somewhere that recommend the use of the 0.2% – 2% for skin antisepsis? Have trawled through the WHO site. The CDC states that the use of Triclosan 0.1% (similar stuff) reduces bacterial counts on hands by 2.8 log (whatever a log is).Can anyone provide me with best practice on using chlohex/Triclosan prior to these kinds of procedures?
Thanks,
Helen Scott
Infection Control Co-ordinator
Nepean Private Hospital
Penrith, NSW.
0247 327333
Helen.Scott@healthscope.com.auPlease consider the environment before printing this message
Michael Wishart
Public Health Nurse,Communicable Disease Control Logan West Moreton PHU Ph 34131200 Fax 34131221
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Dear Helen,
Yes, Skinman Soft N (Ecolab, formerly Henkel, distributed in Australia by Orion) is one of the formulations that are suitable for surgical hand antisepsis and it fulfils EN 12791.
Sorry, which article in MMWR do you mean? I could not find it in the 2002 list of articles:
http://www.cdc.gov/mmwr/index2002.htm
Note, there is also another article from a US perspective in the AORN Journal in 2004:
http://www.sciencedirect.com/science/article/pii/S0001209206606194
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 1387From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Helen Scott
Sent: Tuesday, 12 June, 2012 12:36 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical hand scrubHi Jane,
The CDC have got a good article on this. It’s their MMWR and in October 2002, Vol 51, page 17 it discusses exactly this. I’m sure there’s a more up to date report somewhere. You could also try Skinman Soft, made by Orion.
Cheers,
Helen.Helen Scott
Infection Control Co-ordinator
Nepean Private Hospital
Penrith, NSW.
0247 327333
Helen.Scott@healthscope.com.auPlease consider the environment before printing this message
>>> On 11/06/2012 at 5:50 am, in message <5CF778CD399D414080027BBC8F4991D83567DA@mschcexp07.cdhb.local>, Jane Barnett <Jane.Barnett@CDHB.HEALTH.NZ> wrote:
Hi
Weve got some staff who can only use the PCMX scrub product as they are sensitive to both chlorhex and betadine but BD have advised that they are withdrawing this product. Can I ask what other centres are doing for staff with allergies would plain soap and water washed followed by plain alcohol (without antiseptic additive) be sufficient for surgical procedures? Thoughts/ideas welcome.
ThanksJane Barnett
Clinical Nurse Specialist
Infection Prevention & Control
Christchurch Women’s Hospital
Private Bag 4711, Christchurch
Tel: 03 364 4510 (int 85510)
Fax: 03 364 4607Infection Prevention and Control is Everyone’s Business
________________________________Attention:
The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies.Thank You.
________________________________
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Hi Jane,
Alcohol products are perfectly adequate for surgical hand and arm antisepsis. There is a chapter in the 2009 WHO Hand Hygiene Guideline, starting on page 54, and a similar article (by some of the same authors) in J Hosp Infect:
http://www.ncbi.nlm.nih.gov/pubmed/19716627
In fact, alcohol products for surgical hand antisepsis (a) provide far greater microbial reduction than aqueous detergent products such as chlorhexidine and betadine scrubs, and (b) are generally better tolerated on skin than detergent products, but (c) so far there is no study that the better microbial reduction on hands translates into lesser surgical site infections.
I would personally recommend against (!) using alcohol gels for that purpose, because the gel residue is often sticky and will be uncomfortable under the gloves.
My recommendation would be to look for a product that meets the European standard EN 12791 for surgical hand antisepsis, because this is a very stringent standard and products that meet it generally have very good performance.
Typical alcohol products that are designed for surgical hand antisepsis often consist of blends of different alcohol types (e.g. a certain percentage of isopropanol plus n-propanol, etc.), because iso- and n-propanol have greater relative antimicrobial efficacy than ethanol. Some commercial products have some added mecetronium etilsulfate (which is from the quaternary ammonium compounds (QAC) class of disinfectants). But there is generally no need to add chlorhexidine, betadine or PCMX to the alcohol.
There are several decades of practical clinical as well as testing and approval experience of alcohols for surgical hand antisepsis in Europe.
Companies that have products that are suitable for surgical hand antisepsis and meet EN 12791 might include B. Braun, Ecolab, Schuelke and Bode (perhaps others). I have heard that the Australian TGA has started registering alcohol products for surgical hand antisepsis, but I am not sure about the NZ status.
It is important to make sure that hands are clean and dry before using alcohols for surgical hand antisepsis. This can be achieved for the first scrub of the day by a thorough soap hand and arm wash (does not need to be antiseptic soap) and removal of dirt under the fingernails. After the soap wash, it is important to dry hands and arms completely, e.g. with a sterilised towel. Then, the alcohol is rubbed in very liberally (note: the amount is different from a hand rub as in the 5 Moments), typically such that the hands amd arms are being kept wet and being rubbed for the entire period. Typical periods are about 3-5 minutes. For subsequent scrubs on the same day (if hands have not been contaminated by other, e.g. ward work), an alcohol rub alone without prior soap step is sufficient.
There has been discussion whether the WHO-formulated hand rubs (which are excellent for usual hand hygiene and meet EN 1500) meet the surgical standard EN 12791 and proposals have been made for improved WHO formulations (however, this is more relevant for low-resource settings which would benefit most from cheap standard formulations):
http://www.ncbi.nlm.nih.gov/pubmed/21450366
http://www.ncbi.nlm.nih.gov/pubmed/21741115
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 1387Hi
We’ve got some staff who can only use the PCMX scrub product as they are sensitive to both chlorhex and betadine but BD have advised that they are withdrawing this product. Can I ask what other centres are doing for staff with allergies – would plain soap and water washed followed by plain alcohol (without antiseptic additive) be sufficient for surgical procedures? Thoughts/ideas welcome.
ThanksJane Barnett
Clinical Nurse Specialist
Infection Prevention & Control
Christchurch Women’s Hospital
Private Bag 4711, ChristchurchInfection Prevention and Control is Everyone’s Business
________________________________Attention:
The information contained in this message and or attachments is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any system and destroy any copies.Thank You.
________________________________
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Tim,
The wording “still widely accepted” and “current best practices . . . recommends” — although admittedly not stating it clearly — implies that 70% IPA is somewhat inferior and CHG and IPA is somewhat superior to IPA alone.
Again, the evidence to support such implied wording is very weak at best. One would have to query the definition of what exactly “current best practices” means.
I agree that when a unit is already using CHG plus IPA for skin antisepsis, it can be beneficial — for uniform practices purposes — to use that also for ports, since it is most likely not a disadvantage.
Contrary to what is quoted from the CDC guidelines, there is absolutely no evidence to support “chlorhexidine” (by omission implying on its own) for that purpose.
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
________________________________In reply to general CHG comments so far;
CHG must be relatively safe for in vivo use, as it is impreganted into many of our vascular devices (CVC and PICCs) commonly used these days – there has only been relatively few isolated cases in Japan and the USA from several years ago.Matthias,
They might be fundamentally different things, but as a lead vascular access nurse, I think compliance is more of the issue between healthcare practitioners and their standard of care, than of two different types of decontamination issues. I agree with you that 70% IPA is still widely accepted and used for port decontamination, but current best practices also recommends the use of CHG and IPA.CDC Guidelines (2011) pp.19-20 recommend;
4. Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70% alcohol) and accessing the port only with sterile devices [189, 192, 194196]. Category IA
Although to monitor compliance more effectively CDC also recommend;
Use hospital-specific or collaborative-based performance improvement initiatives in which multifaceted strategies are “bundled” together to improve compliance with evidence-based recommended practices [15, 69, 70, 201205]. Category IB
Regards,
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
________________________________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
________________________________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.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
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kkh
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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
________________________________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.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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[cid:kkh156a.gif]kkh
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