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Hi Jenny,
There is lots of supportive evidence for 2%CHG in 70%IPA, particularly for invasive device skin preparation (CVC/PICC/PIVC,ICC/Epidural, etc,etc..)
Here is a link to Dr William Jarvis discussing the differences of various skin preps.
http://www.medscape.com/viewarticle/761489
There is both a video of the discussion..
To cut to the conclusion;
The findings were very interesting. Of greatest importance, the investigators found that all products (0.5% chlorhexidine with ethanol, 1% chlorhexidine with ethanol, and 2% chlorhexidine with isopropyl alcohol) were equally effective. This will be very helpful information when you are trying to select a product for preparation of the insertion site for intravascular catheters or for a preoperative surgical antiseptic. Chlorhexidine is effective, and different concentrations of chlorhexidine are equally effective, with no statistically significant difference in colony counts. All of these products should be equally beneficial to patients in preventing central line-associated bloodstream infections or surgical site infections.Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
President, Australian Vascular Access Society
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBe a yardstick of quality. Some people aren’t used to an environment where excellence is expected. Steve Jobs
________________________________Hi all – not sure if this has already been discussed and apologies if it has – one of the orthopaedic surgeons here is requesting Chlorhexidine 2% with 70% alcohol (tinted red) as opposed to the 0.5% with 70% alcohol for skin prep. Firstly, is there an advantage to using the 2% as opposed to the 0.5% and if so would anyone have any literature to support this
Thanks
Jenny McCarthy
Maryvale Private HospitalMaryvale Private Hospital Confidentiality and Privacy Notice
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Hi Andrea,
There is a 2%CHG & 70% IPA skin prep used for invasive procedures that
comes in a tinted red colour in a large style swab stick applicator.We use these for all our CVAD insertions and changed from a clear-based
skin prep after the intrathecal injection of CHG/IPA some time ago.It is widely available , so if this solution is something to consider,
contact your local state representative.I can provide further information off list should you require.
The solutions are available in various %’s of CHG and alcohol/aqueous
preparations, so there should be something that can satisfy your
surgeon.I have contacted the TGA in regards to off-label (raised by MW) use and
they have stated they have no current position on this (which is not
very helpful).I’m looking for the related email from TGA but I can’t seem to find it –
if so, I will forward to you off list..Regards,
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au“Be a yardstick of quality. Some people aren’t used to an environment
where excellence is expected.” – Steve JobsBehalf Of Grimes, Andrea
Good morning all,
I have a very irate surgeon who would like to use a red skin
prep(Chlorhexidine 0.5% in 70% Alcohol, tinted red). We no longer supply
this product for skin use.I had heard that some larger facilities are compounding their own?
Has anyone heard of any developments to this issue?
All replies greatly appreciated.
Cheers, Andrea
Andrea Grimes | IC | H&S | RRTWC
Ramsay Cairns | The Cairns Clinic | Cairns Day Surgery | Cairns Private
Hospital
t: 07 4052 5274 | m: 0439 392 819
e: grimesa@ramsayhealth.com.au | w: http://www.ramsayhealth.com.auhttp://www.ramsayhealth.com.au/images/email/RHC-email-2013.jpg
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If clinicians have difficulty converting time zones from around the
world (for webinars, online education programs, etc)Try http://www.timeanddate.com/
This is the easiest way to check what is the correct time.
J
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au“Be a yardstick of quality. Some people aren’t used to an environment
where excellence is expected.” – Steve JobsBehalf Of Tim Spencer
Marie,
These are USA timezones, not Australian.
The webinar is at 0400 EST (EST Australian (Sydney) time)
You are in WA so add 3 hrs to that..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
200 yeas logo white.jpg“Be a yardstick of quality. Some people aren’t used to an environment
where excellence is expected.” – Steve JobsBehalf Of Marie Murphy
We have been trying to access the Webinar Post-Insertion Vascular access
Device care scheduled for 12.00 EST which is 09.00 PST. The message kept
saying the webinar is not yet open to attendees come back at scheduled
time. I’m not sure why this is happening given that it is way passed
09.00 PST. Is there any way we can get a recording of the webinar when
it’s finished?I have also emailed the support email at:
webinair@saxecommunications.com and am awaiting a replyThanks for your help
Marie Murphy PhD, BSc (Hons), RN
Learning & DevelopmentManager
Bethesda Hospital________________________________
25 Queenslea Drive | Claremont | WA | 6010
Tel +61 8 9340 6499 | Fax +61 8 9340 6398Pager 038
Email
Web
________________________________
This email including attached files are confidential and intended only
for the person or entity to which it is addressed and may contain
confidential information. If you are not the intended recipient please
notify the sender immediately and delete the e-mail from your system
furthermore use, redistribution or copying is not authorised. any views
or opinions presented in this email are solely those of the author and
do not necessarily represent those of Bethesda Hospital Inc. It is the
recipients responsibility to check for the presence of viruses. Bethesda
Hospital Inc accepts no liability for any damage caused by receipt of
this email._____________________________________________________________________
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New York
(U.S.A. – New York)Thursday, 13 February 2014 at 12:00:00 Noon
EST
UTC-5 hours
Perth
(Australia – Western Australia)Friday, 14 February 2014 at 1:00:00 AM
AWST
UTC+8 hours
Corresponding UTC (GMT)
Thursday, 13 February 2014 at 17:00:00
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au“Be a yardstick of quality. Some people aren’t used to an environment
where excellence is expected.” – Steve JobsBehalf Of Marie Murphy
We have been trying to access the Webinar Post-Insertion Vascular access
Device care scheduled for 12.00 EST which is 09.00 PST. The message kept
saying the webinar is not yet open to attendees come back at scheduled
time. I’m not sure why this is happening given that it is way passed
09.00 PST. Is there any way we can get a recording of the webinar when
it’s finished?I have also emailed the support email at:
webinair@saxecommunications.com and am awaiting a replyThanks for your help
Marie Murphy PhD, BSc (Hons), RN
Learning & DevelopmentManager
Bethesda Hospital________________________________
25 Queenslea Drive | Claremont | WA | 6010
Tel +61 8 9340 6499 | Fax +61 8 9340 6398Pager 038
Email
Web
________________________________
This email including attached files are confidential and intended only
for the person or entity to which it is addressed and may contain
confidential information. If you are not the intended recipient please
notify the sender immediately and delete the e-mail from your system
furthermore use, redistribution or copying is not authorised. any views
or opinions presented in this email are solely those of the author and
do not necessarily represent those of Bethesda Hospital Inc. It is the
recipients responsibility to check for the presence of viruses. Bethesda
Hospital Inc accepts no liability for any damage caused by receipt of
this email._____________________________________________________________________
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Health Districts by the MessageLabs Email Security System.
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Marie,
These are USA timezones, not Australian.
The webinar is at 0400 EST (EST Australian (Sydney) time)
You are in WA so add 3 hrs to that..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au“Be a yardstick of quality. Some people aren’t used to an environment
where excellence is expected.” – Steve JobsBehalf Of Marie Murphy
We have been trying to access the Webinar Post-Insertion Vascular access
Device care scheduled for 12.00 EST which is 09.00 PST. The message kept
saying the webinar is not yet open to attendees come back at scheduled
time. I’m not sure why this is happening given that it is way passed
09.00 PST. Is there any way we can get a recording of the webinar when
it’s finished?I have also emailed the support email at:
webinair@saxecommunications.com and am awaiting a replyThanks for your help
Marie Murphy PhD, BSc (Hons), RN
Learning & DevelopmentManager
Bethesda Hospital________________________________
25 Queenslea Drive | Claremont | WA | 6010
Tel +61 8 9340 6499 | Fax +61 8 9340 6398Pager 038
Email
Web
________________________________
This email including attached files are confidential and intended only
for the person or entity to which it is addressed and may contain
confidential information. If you are not the intended recipient please
notify the sender immediately and delete the e-mail from your system
furthermore use, redistribution or copying is not authorised. any views
or opinions presented in this email are solely those of the author and
do not necessarily represent those of Bethesda Hospital Inc. It is the
recipients responsibility to check for the presence of viruses. Bethesda
Hospital Inc accepts no liability for any damage caused by receipt of
this email._____________________________________________________________________
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Hi Fiona,
Sorry for the delayed reply as I have just returned from the USA.
CDC 2011 recommend the following;
Skin Preparation
Recommendations
1. Prepare clean skin with an antiseptic (70% alcohol,
tincture of iodine, an iodophor or chlorhexidine gluconate) before
peripheral venous catheter insertion [82]. Category IB2. Prepare clean skin with a >0.5% chlorhexidine preparation
with alcohol before central venous catheter and peripheral arterial
catheter insertion and during dressing changes. If there is a
contraindication to chlorhexidine, tincture of iodine, an iodophor, or
70% alcohol can be used as alternatives [82, 83]. Category IA3. No comparison has been made between using chlorhexidine
preparations with alcohol and povidone-iodine in alcohol to prepare
clean skin. Unresolved issue.4. No recommendation can be made for the safety or efficacy
of chlorhexidine in infants aged
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
185 Fox Valley Road, Wahroonga, NSW, 2076
information intended for the addressee named above.
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Hi Beth,
For ALL CVAD insertions, we recommend and perform fingertip to elbow 2min CHG scrub.
If dressing or administration set change, fingertip to wrist 2min CHG scrub as both procedures should be performed with sterile gloves.Regards,
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 +61(0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au—–Original Message—–
Good morning Brains TrustI have to declare my age may be influencing my opinion on this subject.
Could you please advise as to what the recommended hygiene procedure would be for the following invasive procedures examples undertaken in in the clinical setting.
Would be:
a. fingertip to wrist, or
b. finger to elbow.
I acknowledge that an antimicrobial solution would be recommended for either of these hand hygiene methods.
Examples of invasive procedures:
1. Insertion of PICC or Central line
2. Insertion of Indwelling urinary catheter
3. Insertion of Chest Tube
If you recommend fingertip to wrist, could you please provide the reference to for this practice.
Thank you
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
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Heres one more 😉
Department of Access Management and Infusion Therapy (DAMIT)
Enjoy your evening everyone.
T..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBe a yardstick of quality. Some people aren’t used to an environment where excellence is expected. Steve Jobs
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Tuesday, 29 October 2013 4:52 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Suggestions for names for a IV/PICC teamsHow about Vascular Access Management Team VAMT (vamped). Its catchy!!
Cheers
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email
International Infection Prevention Week 2012
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Claire Rickard
Sent: Tuesday, 29 October 2013 3:46 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Suggestions for names for a IV/PICC teamsHave seen IVADHeroes, and VAST around….If you are ok acronym free what about WeLoveLines ?!?!
Kind regards,
Prof Claire Rickard
NHMRC Centre for Research Excellence in Nursing Interventions
Griffith University
——– Original message ——–
From: Craig Boutlis
Date:
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Suggestions for names for a IV/PICC teamsiVee team
Craig Boutlis
Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Kerry Taliaferro
Sent: Monday, 28 October 2013 11:37 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Suggestions for names for a IV/PICC teamsHi All
At Canberra Hospital we are implementing a Vascular Aceess Team – only the abbreviation VAT is already in use for several other medical procedures etc.
I am looking for ideas of what we should call our team/service- we will be inserting PICC lines, difficult cannulas, monitoring central lines etc. We need to make sure that staff and patients recognise what we do from the name as well!Any suggestions for a name that can also be a catchy acronym?
Thanks Kerry Taliaferro
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HISIFIT – Hospital-wide Intravenous Service Introduced For Infection Thwarting..
😉
Regards, 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 +61(0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au________________________________
HIT
Hospital Intravascular TeamCath Wade
Director
Healthcare & Infection Prevention—–Original Message—–
Hi All
At Canberra Hospital we are implementing a Vascular Aceess Team – only the abbreviation VAT is already in use for several other medical procedures etc.
I am looking for ideas of what we should call our team/service- we will be inserting PICC lines, difficult cannulas, monitoring central lines etc. We need to make sure that staff and patients recognise what we do from the name as well!Any suggestions for a name that can also be a catchy acronym?
Thanks Kerry Taliaferro
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The Prof has spoken..
I would have said and referred the same.
Here are a few current guideline statements.
CDC Guidelines Statement; (p. 53)
Replacement of Administration Sets
Recommendations
1. In patients not receiving blood, blood products or fat emulsions,
replace administration sets that are continuously used, including
secondary sets and add-on devices, no more frequently than at 96-hour
intervals, [177] but at least every 7 days [178-181]. Category IA2. No recommendation can be made regarding the frequency for replacing
intermittently used administration sets. Unresolved issue3. No recommendation can be made regarding the frequency for replacing
needles to access implantable ports. Unresolved issue4. Replace tubing used to administer blood, blood products, or fat
emulsions (those combined with amino acids and glucose in a 3-in-1
admixture or infused separately) within 24 hours of initiating the
infusion [182-185]. Category IB5. Replace tubing used to administer propofol infusions every 6 or 12
hours, when the vial is changed, per the manufacturer’s recommendation
(FDA website Medwatch) *186+. Category IA6. No recommendation can be made regarding the length of time a needle
used to access implanted ports can remain in place. Unresolved issueINS Guidelines Statement;
43. ADMINISTRATION SET CHANGE (p. S55)
Practice Criteria
I. General
A. The use of add-on devices for administration sets should be minimized
as each device is a potential source of contamination, misuse, and
disconnection; it is preferable to use an administration set with
devices as an integral part of the set (see Standard 26, Add-on
Devices).1 (V)Practice Criteria
II. Primary and Secondary Continuous Infusions
A. Primary and secondary continuous administration sets used to
administer fluids other than lipid, blood, or blood products should be
changed no more frequently than every 96 hours. There is strong evidence
that changing the administration sets more frequently does not decrease
the risk of infection.2-3 (I)B. Extending the administration set change to every 7 days may be
considered when an anti-infective central vascular access device (CVAD)
is being used or if fluids that enhance microbial growthare not administered through the set.3,4 (II)
C. If a secondary administration set is detached from the primary
administration set, the secondary administration set is considered a
primary intermittent administration set and should be changedevery 24 hours (see Practice Criteria III, Primary Intermittent
Infusions).1 (V)D. When compatibility of infusates is verified, use of secondary
administration sets that use back-priming infusion methods are preferred
due to reduced need for disconnecting secondary intermittent
administration sets.1 (V)Practice Criteria
III. Primary Intermittent Infusions
A. Primary intermittent administration sets should be changed every 24
hours. When an intermittent infusion is repeatedly disconnected and
reconnected for the infusion, there is increased risk of contamination
at the catheter hub, needleless connector, and the male luer end of the
administration set, potentially increasing risk for catheter-related
bloodstream infection. There is an absence ofstudies addressing administration set changes for intermittent
infusions. In a meta-analysis of 12 randomized, controlled trials that
supported increasing the time interval for administration setchanges to 96 hours, at least 2 of the studies excluded administration
sets used for heparin locked catheters and in sets disconnected for more
than 4 hours. In several others, exclusions werenot stated.1,5 (V)
B. A new, sterile, compatible covering device should be aseptically
attached to the end of the administration set after each intermittent
use. The practice of attaching the exposed end of the administration set
to a port on the same set (“looping”) should be avoided.1,5 (V)Another reference of use is below;
McDonald LC, Banerjee SN, Jarvis WR. Line-associated bloodstream
infections in pediatric intensive-care-unit patients associated with a
needleless device and intermittent intravenous therapy. Infect Control
Hosp Epidemiol 1998; 19:772-7.Regards,
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBehalf Of Claire Rickard
Hi Christine
I agree, this DRIVES ME NUTS.
This was published in the RCNA magazine last year…hope it’s of some
use…Routine disconnection of continuous intravenous therapy: implications
for your patients’ recoveryBy Amanda Ullman and Nicole Marsh
A patient under your care who is currently receiving continuous
intravenous therapy wants to have a shower. In order to facilitate this,
you disconnect their IV from their infusion, right? No.“Nurses who disconnect their patients’ IV tubing during continuous
intravenous therapy are trying to be flexible and accommodating, however
this practice may have a significant impact on the patients’ health and
recovery” says Professor Rickard (FRCNA), a leading nurse researcher in
the field of Intravascular Device (IVD) management from the Griffith
Health Institute’s NHMRC Centre of Research Excellence in Nursing.In earlier times it was commonplace to see ambulant patients pushing
their IV drip poles around hospital corridors. “Nowadays, it seems to
have become the unofficial, but standard practice to disconnect IV
tubing while patients have showers, or just go for a walk” said Rickard
“It’s really commonplace now to see disconnected IV tubing lying on
patients’ beds, or hooked onto IV poles. It’s quite concerning because
maintaining sterility of IV circuits is vital in preventing infection,
and there’s also issues in interrupting prescribed therapy’.To overcome infection control concerns, some wards discard the
disconnected tubing, and then replace this with new sterile fluids and
tubing when the patient returns. But it’s still not good enough
according to Professor Rickard. She says “with hospital budgets as they
are, we can’t afford to be routinely discarding expensive disposable
equipment, not to mention infusion fluids and drugs, sometimes even
parenteral nutrition. If we just left the lines intact, hospitals would
literally save tens of thousands of dollars off their budgets each
year”.Another trend in therapy has been for nurses to use a new 100mL normal
saline fluid bag and IV tubing set for each dose of intermittent
antibiotics. This supersedes the earlier practice of leaving a 1000mL
bag and line attached to the IVD, with a burette in the circuit used for
medication doses, with the saline infusing slowly in between doses.
Again, Rickard questions whether this has been progress or a backwards
step.“Hanging a new 100ml bag and administration set for a sixth hourly
antibiotic costs $44.36, compared with leaving a 1 litre bag and line
connected which costs $9.15” says Rickard. The main problem though is
not expense, it’s the repeated interruptions to the circuit. “This
approach means the IVD hub, a common source of infection, is handled
eight times a day, compared to no handling with the use of a ‘keep vein
open’ litre bag and line. There’s no way we can guarantee that all staff
are going to take the time to properly undertake hand hygiene,
decontaminate the connectors with alcoholic chlorhexidine (plus letting
it dry), before accessing the system on all occasions”.Intravenous therapy is defined as a set of knowledge and techniques
aimed at administering solutions or drugs in the circulatory system and
covers different care aspects, ranging from the patient’s preparation to
intervention in the event of complications to obtaining the desired
outcome (Jacinto, Avelar, & Pedreira, 2011). It comprises interventions that are complex and can lead to
complications that can jeopardize patient safety (Jacinto et al., 2011).
Continuous intravenous therapy can run for hours, days or weeks. When
continuous intravenous therapy is disconnected, the nurse is altering
the patient’s ability to reach therapeutic goals (Webster, Osborne,
Rickard, & Hall, 2010). This variation in therapy may have an adverse effect on the patient’s
clinical condition and long-term outcomes. This is impacted by the
medications or fluids being administered, but as a minimum it will have
an impact on the patients’ fluid and electrolyte balance.The frequent disconnection of intravenous administration sets from the
IVD may also increase the ability of potentially infection-causing
bacteria to contaminate and colonise the IVD hub. This bacterium may
then potentially enter the blood-stream causing systemic infection (
O’Grady et al., 2011).
In addition to contamination, there is the risk of accidentally
connecting the wrong tubing back to the IVD. There are numerous adverse
events documented in literature, including patient deaths, from tubing
misconnections.The main reason for disconnecting an IVD receiving a continuous infusion
should be to discontinue therapy, routinely change the administration
sets at between four and seven days, (24hourly for blood, blood
products, fat emulsions or propofol) (O’Grady et al., 2011
)
or in an emergency.Professor Rickard says “all nurses have a responsibility to provide
evidence-based practice to their patients. The routine interruption of
continuous intravenous therapy is not beneficial to our patients”.References
Jacinto, A., Avelar, A., & Pedreira, M. (2011). Predisposing factors for
infiltration in children submitted to peripheral venous catheterization.
Journal of Infusion Nursing, 34(6), 391-398.O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland,
J., O’Heard, S., . . . Healthcare Infection Control Practices Advisory
Committee (HICPAC). (2011). Guidelines for the prevention of
intravascular catheter-related infections. Clinical Infectious Diseases,
52(9), e162-193.Webster, J., Osborne, S., Rickard, C., & Hall, J. (2010).
Clinically-indicated replacement versus routine replacement of
peripheral venous catheters. Cochrane Database of Systematic Reviews,
17(3), CD007798.Best regards, Claire
Professor Claire Rickard RN PhD
54886)
c.rickard@griffith.edu.au | +61 (0)7 3735 6460 | Skype: clairexm1 |
http://www.griffith.edu.au/health/centre-health-practice-innovation/rese
arch/acute-critical-care/intravascular-devicesAustralian Vascular Access Teaching and Research Group | NHMRC Centre of
Research Excellence in Nursing Interventions | Griffith Health Institute
Centre for Health Practice Innovation | Royal Brisbane & Women’s
Hospital | Princess Alexandra Hospital | The Prince Charles HospitalResearch frequently takes me off campus. Please contact
Jo.Wright@griffith.edu.au 3735 4886,
or the School Secretary (Nathan) Jenny Chan 3735 5406
j.chan@griffith.edu.au for urgent
enquiries.It’s nice to be important, but it’s more important to be nice. John
Cassis.On 23 August 2013 14:05, Chris Braden wrote:
Hi Everyone,
I have an aversion to IV giving sets being disconnected from the patient
following intermittent antibiotic administration, connected to a hanging
IV bag and reconnected to the patient 6 hours + when the next Anti is
due.Wondering if anyone can point me in the right direction for some
evidence for support or am I being pedantic?Regards
Chris
Christine Braden
Manager Infection Control
Djerriwarrh Health Service
Email- chrisb@djhs.org.au
Ph- 53 67 2000
Mobile – 0402 242 651
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Here is the ACI audit tool.
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auHi Helen
We audited the form for the CVL insertion – analysed the aseptic technique bundle. This audit was able to be used for aseptic technique and insertion of invasive devices
Thanks
Joe-Anne Bendall
Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital8 Macquarie St
SYDNEY NSW 2000
|( ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU
Hi,
Does anyone have an audit tool for Invasive Devices to meet standard 3.8.1?
I have audit tools for PIVCs, wounds, venepuncture and urinary catheters.
I don’t have an audit tool I can use specifically for CVADs, UWSDs, wound drains and epidurals.
Thanks,
Helen.
Helen Scott
Infection Control Co-ordinator |
Staff Educator |
Nepean Private Hospital
Kingswood, NSW.
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Hi James,
Good question.
To answer your question about best conducting medium, sterile ultrasound gel is the BEST conducting medium for transmission of image from the skin. It is designed specifically for that purpose.1. I have been using US for VA for almost 10years now and I always use sterile gel – I have not had an issue of the gel smudging the CHG on the skin, as it well dried before I put needle to skin.
A handy tip I perform that you might be interested in trying is once you have located your insertion point for puncture, with the probe in place, gently wipe down the edge of the probe against the skin to remove any excess gel that bulges out from under the probe. This reduces the risk of getting gel in the tip of the needle (which reduces your flashback indicator also).2. Sterile saline isn’t a great conductor for image transmission.
3. Wet CHG is at risk of entering through the puncture site of the skin, and although a very small amount, the risk of CHG reaction is increased.
If the CHG and IPA has completely dried on the skins surface, I find that is not removed when wiping the gel. But I also don’t need a lot of gel usually, just enough to get a clear image of the vessel.
I would send an image, but are unable to do so on this listserver.Alternatively, you could reapply your CHG/IPA after cleaning the area to remove blood/gel, etc and put a fresh layer of CHG prior to the dressing application.
Regards,
Tim.Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept ofIntensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 87383603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au—–Original Message—–
Dear Wise Anti-Infection Folk,
When performing vascular access using ultrasound guidance we use standard aseptic technique with 2% chlorhexidine for the skin, and sterile ultrasound probe cover.
Between the skin with dried chlorhexidine, and the probe cover we need an ultrasound conducting medium.
My question relates to what is the best sound conducting medium.
Options are:
1. Sterile ultrasound gel.
Putting the needle through gel into the patient bothers me, and the gel makes things slippery and awkward if needing to advance a wire for the Seldinger technique. Also wiping the gel off afterwards so a dressing will stick removes the chlorhexidine.2. Sterile saline.
Works well, isn’t slippery, but washes away the chlorhexidine.3. More chlorhexidine.
Works well, isn’t slippery, but means we put a needle through wet chlorhexidine into the patient.I anticipate the amount of chlorhexidine introduced if we go through wet chlorhexidine with a needle is miniscule, and this is probably the best option, but seek your advice.
Many thanks in anticipation.
James Rippey
MBBS DDU DCH FACEM
Specialist in Emergency Medicine
Sub specialty Emergency UltrasoundAssociate Professor
University of Western Australia
Sir Charles Gairdner Hospital &
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Just out of interest, we looked at skin antisepsis in this recent article looking at CVC insertion as part of a systematic review.
http://www.swslhd.nsw.gov.au/Liverpool/CVAS%5Ccontent/pdf/Articles/Yacopett_et_al_2013.pdf
Regards,
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 +61(0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au—–Original Message—–
Hi Cath, hi Michael,I agree with Michael — not that Cath was fundamentally different on that issue — that (a) classical skin antisepsis before surgical incision (‘surgical skin prep’) and (b) antiseptic body washing or showering in the preoprerative phase (that includes preoperative antiseptic body wiping with cloths) are two fundamentally different processes, both biologically and clinically.
Classical skin antisepsis is extremely well supported by evidence plus carries a clear scientific rationale:
(1) Historically, skin antisepsis before iatrogenic skin breaks has been used since the 1890s (e.g. a paper by Harrington & Walker 1903 stated it was in widespread use).
(2) There is a clear biological and microbiological theoretical framework supporting it, i.e. there is biological plausibility. This includes the fact that well-conducted skin antisepsis reduces microbe counts on skin by anywhere between 2 log and 4 log (a factor of 100-10,000) and that microorganisms from patients’ skin are known to cause surgical site infections.
(3) That based on microbiological testing — both in reagent tubes and on real skin — antiseptics can be categorised (that includes regulatory purposes by product approval agencies) into stronger and weaker ones, and some that pass standards and others that don’t.
(4) That outcomes from clinical trials, including very well conducted (i.e. high-level evidence) randomised clinical trials by and large reflect the outcomes from microbiological testing.
So, we have various angles of strong support here.Preoperative antiseptic body washing is much less supported overall. This is also reflected by the statement in the draft text passage that Cath sent, saying that although showering or bathing should be done (note, no antiseptic stated here), it says “No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications.” That means the draft does not necessarily imply that this should be done with antiseptics. The use of antiseptics for that purpose follows a reasonably good rationale and has biological plausibility, but support from high-quality randomised clinical trials is currently lacking. The latter also became clear in a recently-updated Cochrane review by Webster & Osborne (authors from QLD) in 2012. Microbiologically, antiseptic body washing achieves far lesser microbial reduction on skin than classical skin antisepsis. There are several other non-randomised (e.g. observational) clinical studies showing a benefit from antiseptic washing, and they should definitely not be discounted. These are still providing valuable evidence. But the evidence from the latter type of studies is not quite as clear-cut as one would wish, just as an example, by coincidence there were two almost back-to-back recently-appeared (but in different journals) papers, one by Kapadia et al. 2013, the other by Farber et al. 2013. One was antiseptic-industry-supported, the other not. The industry-supported paper showed a benefit, the other not. Just a few interesting observations here . . .
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 1387Michael
CDC does not typically drill down to the minutia level of applications. Under FDA and OSHA legislation I am sure that the assumptions rightly or wrongly are that manufacturers label as per their submission for registration and testing and that clinicians follow label instructions. Australia is no different.
Below is an interesting point about intraoperative skin prep and solution of choice.
There are also many in-press publications about CHG bathing pre-operatively as an additional measure.
We have to remain on top of all this research and public policy and it’s very time consuming and not easy without formal training in reading and understanding scientific papers. Our lot in life I guess.
JUNE 2013 UPDATED
8B. Perform intraoperative skin preparation with an appropriate antiseptic agent. (Category IA)
8B.1.a. Use chlorhexidine gluconate-alcohol in preference of aqueous iodophor skin preparation, unless contraindicated. (Category IA)
8B.1.b. No recommendation can be made regarding the safety and effectiveness of chlorhexidine gluconate-alcohol as compared to iodophor-alcohol skin preparation.(No recommendation/unresolved issue)Cheers
CathThanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
Cheers
MichaelMichael Wishart
CNC Infection Control
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
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
MichaelMichael Wishart
CNC Infection Control
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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Chris,
A bonus for doctors? For performing hand hygiene!!
Hmmm, that would cause outrage with other clinicians who would not get a
bonus for the same thing.Its everyone’s responsibility to prevent infection – they should be no
financial reward for doing what our patients expect us to be doing
properly!However, your comment on performance indicators in training is valid and
something that should be considered.Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBehalf Of Christian HARKENSEE
or groupMy suggestions: Make hand hygiene a performance indicator essential for
training progress (junior doctors) or quality of care/bonus payments
(senior doctors). Without a minimum score in hand hygiene compliance –
no career advancement or bonus! It seems it has to hurt for people to
really comply, in particular when a culture of hand hygiene is not well
established… Obviously, you will need support and endorsement of any
such policy from senior management!Chris Harkensee
Dr Christian Harkensee MD, PhD, MRCPCH(UK), PG Dip Infect Dis (Univ. of
London)Assistant Professor in Paediatrics, National University Singapore
Consultant Paediatrician
Division of Paediatric Infectious Diseases
Khoo Teck Phuat – National University Children”s Medical Institute
National University Hospital
1E Kent Ridge Road
NUHS Tower Block, Level 12, Singapore 119228
Behalf Of Parsons, Phillipa
groupDear All,
Has anyone attempted to write or have in place a policy or procedure for
hand hygiene non-compliance?Does anyone have a management plan for managing this issue?
Any suggestions anyone. I have been asked to write one.
I have looked at ‘disciplinary procedure’ and accreditation guidelines
for medical officers as a starting point.Regards
Phillipa Parsons
Infection Prevention and Control Clinical Coordinator
Cabrini Health
183 Wattletree Rd
Malvern Vic 3144
03 9508 1577
0400 369 741
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Michael,
Seems to add unnecessary expense to me.. even if the swabs are low cost.
If skin prepping is done correctly the first time, I see no need to
‘double prep’, although I do know a clinician who does before placing a
PICC.I do have a little literature (for VA), but it’s not as current as what
you might be after.Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition
ServiceConjoint Lecturer, South West Sydney Clinical School | Faculty of
Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auBehalf Of Michael Wishart
Hi all
Can I ask a question which may seem naive to those with a recent theatre
background? When applying antiseptic solution as part of a surgical skin
preparation prior to a procedure, is it best practice to apply two
‘coats’ of antiseptic solution, one immediately on top of the other,
using different swabs?I can see not real benefit in doing this from an antiseptic action
viewpoint (apart from mechanical friction) Can also not see this
mentioned in a cursory review of any SSI prevention best practice
guidelines.Any comments? Any references to get me up-to-date if I need to be
updated?Thanks
Michael
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email
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