Hi Lynn,
I saw a couple posts on this site related to the use of IPA vs. CHGw/IPA on CVC devices. We had been using CHGw/IPA and have recently switched back to IPA only. I find the literature confusing. The CDC Guidelines do state CHG does decrease the microbial load on devices,but we have also experienced stuck cpas and IV tubing leadig to CVC repairs and PICC exchanges and in the extreme cases the line had to be removed. What are your thoughtson this issue. It is extremely difficult to make the best decision related to this question. Also, what about the protector caps? Have the use recommendations changed? The companies market these devices explaining the cap can be removed and the device accessed without any further scrubbing..thoughts on this? I am reading alot of support for the use of the friction scrub, which would then require two steps and two products for each time the line is accessed.
Thank you for any informaiton you can provide,
Julie Stalf, MSN, RN, VA-BC
First, CHG was introduced to the market as a skin antiseptic agent. At the present time there are no labeled indications to use it as a disinfectant for things like needleless connectors. you are not alone in your confusion. This represents a huge problem for me as I see this as one governmental agency (FDA who dictates label contents) in conflict with the CDC statements about using CHG as a disinfectant. The Soothill study referenced in the CDC guidelines is a very poor study in my opinion. it is a before and after study design comparing using of IPA alone to IPA/CHG. No training was provided before the IPA period of time, just there was staff training before use of the CHG/IPA period. Also there was hand hygiene surveillance happening during the CHG/IPA period. I don't immediately recall the other study listed in CDC however I do know that it is a UK study and there are many differences in methods of practice between the US and UK. Currently, the only data we have about manual scrubbing of needleless connectors comes from many in vitro studies usually showing that a greater length of time is needed to reduce the microbial load on these surfaces. We do not have a study showing that scrubbing with XX agent for XX time reduces CRBSI rates by XX. We do have 3 clinical studies, showing reductions in CRBSI from the use of IPA-impregnated protection/disinfection caps. When the nurse removes the cap, it has been protected and is ready for the attachement of the first saline syringe for assessing catheter function. There can be blood-tinged fluid left on the surface when ths syringe is disconnected, therefore the surface requires cleaning with an alcohol pad again. Then the IV set is attached and is placed in the patient bed for the infusion time, 30-60 minutes, in contact with clothing, linens, body fluids, etc. So the connection surface showed by cleaned again when this infusion set is disconnected and before the second saline syringe is attached. Then if heparin is used, the surface should be manually cleaned again before the final syringe is attached. So that would be 3 separate alcohol swab pads needed for correctly cleaning the connections surface. The length of time for these subsequent cleanings is not known however the INS Standards states the connector requires cleaning before each entry. Based on the absence of clinical studies for manual cleaning and the presence of 3 clinical studies for the protection caps, I think they provide the best option. Lynn
PS My disclosure includes the fact that I consult for BD and B Braun and Baxter, needleless connector manufacturers. And for Excelsior and Ivera, protection cap manufacturers. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861