When teaching a patient at home who is performing SASH through a needless injection cap in succession and has completed the 15 second scrub with alcohol and allowed to dry, do you teach the patient to scrub the hub for 15 seconds between each syringe if the cap is not "contaminated" between each syringe? Does this overwhelm the patients? Do you have Literature to support this. Meeting resistence to change teaching practice. Thank you.
-A
I dont do home care but I certainly teach my nurses to scrub the hub in between each access of the hub. Look in the Infusion Nursing Standards it talks specifically about scrubbing the hub before "any make or breaking of connection to the hub"
They may think they are not contaminating the lines but.....we can not see micro organisms that are on the cap. so.....we must scrub every time, every pt. Remember too that the scrubbing is not eliminating all the micro organisms on the cap it is only eliminating a portion. Once again go find the Infusion nursing standards.
Gina Ward R.N., VA-BC
Gina's comments are exactly the same as mine! Scrub before each and every entry into the system. 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
I was just coming out to the Forum to talk about this very thing! We have put this into our central line policies to scrub before EACH and EVERY access. However, I am in a system-wide convergence group looking at standardizing our central line policies across our system and am getting push-back from most of the other sites about this. I did refer to the INS Standards but they wanted me to look at the references. So I did! I was able to access more than half of the references footnoted for this section and not one of them addressed this practice. Lynn, do have knowledge of any specific references that do recommend this? I have no research to back up what I am saying, at least at this point.
Wendy Erickson RN
Eau Claire WI
The references you have listed in the INS SOP were the most recent at that time. We do not have one single clinical study looking at scrubbing technique, agents, length of contact time, or between each entry - none! The studies we do have are all in vitro. So does that mean we should wait until we have clinical studies for any scrubbing. Don't think anyone would agree to that. So we have to rely upon principles of infection prevention and our own common sense. After the first saline flush, there can easily be blood-tinged fluid left on the connection surface, assuming they are follow SOP by aspirating for a blood return. After the IV set has been connected and in the bed with the patient for 30-60 minutes, I would never attach a saline syringe without another scrub. To me, this is the only evidence we actually have at this point. And it only helps to emphasis that we do have studies with very good outcomes when using the protection caps, but even those will not eliminate these scrubs between the S-A-S-H. Do those in-between scrubs need to be 15 seconds? No one actually knows, but I think cleaning again with a new alcohol pad is important. 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
Just add a point of clarification.....remember the "HUB" of the catheter is the manufacurured luer-lock thread to which you attach an intermittent infusing plug (device..PRN Cap..).
Please correct me is this is incorrect????
Technically, Mark is totally correct. The hub is the female luer-locking part of the actual catheter. The connection surface of the needleless connector is what is scrubbed with each entry. The catheter hub is cleaned when the IV set or needleless connector is changed. Due to campaigns such as Scrub the Hub, we have all become lazy in our descriptions. 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