[Tim Spencer]

Hi Michael,
I find this interesting also.
I use a procedureal area for CVAD insertion, seeing up to 5-8 patients a day.
Quite often, these have an MRO (incl VRE) and I often see these patients towards the end of the day after the ‘non-infectious’ patients.
50% of my patients are immuno-compromised and so I triage my requests lists based around immune and infection status.
Between non-infectious patietns, we don’t get regular decontamination done, however do so after each MRO patient.
What I’d like to know is it necessary to decontaminate betwween patietns who have the same strain of MRO?
My procedureal bay is a large isolation room in our ICU that is NOT used for anythign except my procedures.
I get our after hours cleaner to do the room at the end of the day also.
Interested in hearing peoples thoughts on this also.
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 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

—–Original Message—–

Hi all

Just trying to see what the current thoughts are in regard to management of patients with multi resistant organisms in procedural areas. Do most facilities still have ‘special cleaning’ after procedures on patients colonised or infected with MRSA, ESBL and MRGN’s? I would assume that most facilities would still have special cleaning following procedures on patients colonised or infected with VRE.

In my opinion, provided we have a good process for cleaning the immediate environment between cases, ‘special cleaning’ for MRSA / ESBL / MRGN is not necessary, and these organisms should be easily removed with normal cleaning techniques. The opportunities for widespread environmental colonisation from patients in procedural areas where patient movement is severely controlled is reasonably low, unlike in ward accommodation situations. VRE as an environmentally hardy organism requires a different approach, however. Does anyone else use this approach?

Also, should all MRO patients always be placed last on a list?

Any expert opinions out there?

Thanks
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3326 3523
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[Tim Spencer]

Hi Jayne,
It’s interesting to hear this remark often about ‘allergies’ to
hypoallergenic dressings, such as S+N IV3000 or 3M’s Tegaderm range.
In many cases, it is a reaction between the skin prep/antiseptic and the
adhesive on the dressing because the antiseptic has not been allowed to
dry correctly, and therefore creates a reaction with the dressing
adhesive.
Many people believe this to be an allergy to the dressing!
It is most often likely not.

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

________________________________

Behalf Of Jayne O’Connor

Hi All,

We are currently reviewing our CVAD policies and a question arose around
the use of sterile gauze and tape for those patients who have allergies
to transparent semi permeable dressings. Does anyone have advise on how
frequent the gauze & tape should be changed, apart from the obvious
soiling etc.

Look forward to your responses.

Kind regards

Jayne

Jayne O’Connor RN, BSc.

Clinical Nurse Consultant- Infection Prevention & Control

Sydney Adventist Hospital,

185 Fox Valley Rd,.

Wahroonga,

NSW 2076.

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[Tim Spencer]

Hi Matthias,
This has come up often about the fact that swabsticks are not “sterile”.
I get asked about it alot.
The inability to heat treat for sterilisation with IPA is obviously a
combustable issue. 😉
However, the sterilisation process also has some destabilisation of the
CHG (from what I have heard only).
I am unawwre of ANY other product on the market at the moment that is
completely sterilised for use (that contains CHG and IPA)
If you are happy, would you mind forwarding me the correspondence with
SoluMed as I would like to also investigate this.
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 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

________________________________

Behalf Of Matthias Maiwald (KKH)

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 1387

Behalf Of Tim Spencer

Robert,

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

________________________________

Behalf Of Robert Robinson

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 Robinson

Clinical 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/N
SW-Health-Western-Sydney-LHD.jpg

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[Tim Spencer]

Robert,
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

________________________________

Behalf Of Robert Robinson

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 Robinson

Clinical 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/N
SW-Health-Western-Sydney-LHD.jpg

___________________________________

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[Tim Spencer]

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,
194-196]. 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, 201-205]. 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

________________________________

Behalf Of Matthias Maiwald (KKH)

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

________________________________

Tim Spencer [Tim.Spencer@SSWAHS.NSW.GOV.AU]

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

________________________________

Behalf Of Richards, Matthew

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

________________________________

Behalf Of Tim Spencer
cleaning protocol

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

________________________________

Behalf Of Jayne OConnor

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.

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[Tim Spencer]

I think the big take home point of this too is regardless of the
antiseptic of choice used, you need to create friction on the hubs and
good skin contact prior to device insertion.
Iodine-based solutions however can clog the hub thread and you can get a
buildup of sticky iodine which is a potential risk for device breakages
i.e folk use forceps to unclamp sets/valves/caps.
We follow a “SCRUB THE HUB” for 15secs minimum prior to accessing
devices.
Worked well as a program in the US also a decade ago.
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

________________________________

Behalf Of Michael Wishart

Matthew
The original discussion is concerning port disinfection, and the same
CDC HICPAC guidelines you refer to state:
‘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,
194-196]. Category IA’
Guidelines for the Prevention of Intravascular Catheter-Related
Infections, 2011
http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
Cheers
Michael
Michael Wishart
Public Health Nurse,Communicable Disease Control
Logan West Moreton PHU
Ph 34131200 Fax 34131221
To contact Nursing team:
LWM_PHN@health.qld.gov.au

>>> “Richards, Matthew” 25/05/2012 8:30 am
>>>

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

________________________________

Behalf Of Tim Spencer
cleaning protocol

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

________________________________

Behalf Of Jayne OConnor

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.

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[Tim Spencer]

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

________________________________

Behalf Of Richards, Matthew

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

________________________________

Behalf Of Tim Spencer
cleaning protocol

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

________________________________

Behalf Of Jayne OConnor

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.

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[Tim Spencer]

Yes, an unfortunate incident.
And on that DOH Safety Alert, we changed ALL our CHG & IPA to red tinted
solution.
We also use the large and small lollipops.
However, I think the swabs are still clear – not sure if they come in a
tinted solution.
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

________________________________

Behalf Of Prue Wright

Hi Jayne,

Recently there was a case when a woman was injected with clear
chlorhexidine by error – she was having an epidural inserted .

Because of this; it is preferred that prep for lines be dyed. This also
has the advantage of being able to see what parts of the skin have been
prepped.

The ICU I used to work in used “lollipops”; so there could be no error.

Regards

Prue Wright

Infection Control Co-ordinator

Hurstville Private

Behalf Of Tim Spencer

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

________________________________

Behalf Of Jayne OConnor

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.

information intended for the addressee named above.
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[Tim Spencer]

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

________________________________

Behalf Of Jayne OConnor

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.

information intended for the addressee named above.
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.
_____________________________________________________________________
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[Tim Spencer]

Hi All,
Here is a link to the Smith+Nephew website where several key clinicians
in vascular access designed several tools for audit in 2006.
There are charts for peripheral, central, PICCs as well as a vascular
access device selection tool and phletbitis scoring system.
These are free to downlaod in PDF format if you would like them.
I hope you find these useful.
http://wound.smith-nephew.com/au/node.asp?NodeId4476
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

________________________________

Behalf Of Carien Coleman

Hi Jane,

It would be really nice if you could email me your audit tools.

Thank you,

Carien

Carien Coleman | Infection Control CNC

The Sunshine Coast Private Hospital

Syd Lingard Drive | BUDERIM QLD 4556

PO Box 5050 | Maroochydore BC QLD 4558

T: (07) 5430 3245 | F: (07) 5430 3436

E: carien.coleman@uchealth.com.au

________________________________

Behalf Of Jane Hellsten

Happy to share our audit tools for insertion of peripheral IV cannulae
and also management of peripheral IV’s.

If anyone is interested please email me. Our tools are based on our
in-house protocols which are referenced to CDC guidelines.

14.12.11

Jane Hellsten, CICP

Manager, Infection Prevention Control

Infectious Diseases Service

Loddon Mallee Infection Control Resource Centre

Bendigo Health

Behalf Of Tribe, Ingrid (Health)

We are currently reviewing our audit tool for monitoring compliance with
guidelines for the management of peripheral venous catheters.

Are there any “gold standard” examples available for review? In
anticipation of your response, thank you.

Kind regards

Ingrid Tribe

Infection Control Service

Flinders Medical Centre

Bedford Park SA 5152

Australia

T: (08) 82045051

F: (08) 82044733

E: ingrid.tribe@health.sa.gov.au

Infection prevention is everybody’s business

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[Tim Spencer]

I presume you are talking about the minibag and giving set
administration method?
Leaving disconnected IV sets is not great practice – I certainly would
not be encouraging it at all.
Check the CDC guidelines for more definative info also.
INS (USA) guidelines state;
43. ADMINISTRATION SET
CHANGE
Standard
43.1 Administration set changes shall be performed routinely, based on
factors such as type of solution administered, type of the infusion
(continuous versus intermittent), immediately upon suspected
contamination, or when the integrity of the product or system has been
compromised.
43.2 The administration set shall be changed whenever the peripheral
catheter site is rotated or when a new central vascular access device is
placed.
43.3 Add-on devices used as part of the administration set, such as
single- and multilumen extension sets and filters, shall be changed at
the same time as the administration set.
43.4 The frequency of performing administration set changes and the
system used to promote adherence to administration set change (eg,
labeling/electronic) shall be established in organizational policies,
procedures,
and/or practice guidelines.
43.5 A vented administration set shall be used for solutions supplied in
glass or semi-rigid containers, and a nonvented administration set shall
be used for plastic fluid containers.
43.6 All administration sets shall be of luer-lock design to ensure a
secure junction.

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 growth are 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 changed every 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 of studies addressing
administration set changes for intermittent infusions. In a
meta-analysis of 12 randomized, controlled trials that supported
increasing the time interval for administration set changes to 96 hours,
at least 2 of the studies excluded administration sets used for
heparinlocked catheters and in sets disconnected for more than 4 hours.
In several others, exclusions were not 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)

I hope this is usefiul.
Tim Spencer
Clinical Nurse Consultant
Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Department of Intensive Care
Liverpool Hospital
Locked Bag 7103
Liverpool BC NSW 2170
AUSTRALIA

Please note the prefix change in phone/fax numbers

________________________________

Behalf Of Beckingham, Wendy

Good morning

Our question is: does anyone have a policy on when to change IV lines
that are used for antibiotics and then left to hang disconnected by the
patients bed side?

Would love to hear from you if you do.

Wendy Beckingham
CNC Infection Prevention and Control
ph. (02) 6244 3695 or pager 50390
e. wendy.beckingham@act.gov.au

Care Excellence Collaboration Integrity

GERMS CAN KILL…

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