As a cost saving measure the hospital system value analysis team has suggested removing the CHG applicator from the peripheral IV start kit using the logic put forth in the following statement:
'After extensive search, we were unable to find existing evidence based literature differentiating 70% alcohol vs. CHG skin antiseptic for peripheral catheter site preparation (outcomes, infection or phlebitis rates).....the Pediatric department utilizes 70% alcohol as the skin antiseptic for IV starts.....recommend 70% Alcohol as the primary skin antiseptic (acceptable by the CDC as the low cost alternative)."
My question is...since the standard skin antisepsis for central line insertion includes CHG and the CDC guideline for prevention of intravascular device-related bloodstream infection includes a 1A recommendation at catheter insertion that states CHG is the first choice for cutaneous antisepsis...Why should skin antisepsis be different for a PIV?
I would appreciate if someone could please include a reference to Dr. Jarvis' recent paper on the under reported prevalence of PIV related thrombophlebitis and any other reference materials you may have on the subject.
Thank You-- Robbin George RN VA-BC
All skin antiseptics are listed by CDC for insertion of a PIV due to the lack of studies. This lack of studies extends to PIVs in general. I published a literature review on Short Peripheral Cateters and Infection in the Journal of Infusion Nursing that highlighted the lack of attention to skin antisepsis. You can download this lit review from my website listed below my signature. We have very little evidence of PIV and infection, so my thoughts are why use an antiseptic agent that might not be the best. But 70% alcohol is a great antiseptic agent alone, if used correctly. One or 2 swipes with the alcohol pad is simply not sufficient. As with any agent, you will need to begin with clean skin by a soap and water wash (both INS and CDC), then apply the antiseptic agent with a lot of friction. We also have the manufacturers instructions for back and forth application with CHG/IPA but there are no similar studies using alcohol only. So do you teach circular motion or back and forth with alcohol alone? So alcohol alone may work IF each person uses multiple pads and scrubs until the last one comes away looking clean, then let it dry thoroughly. 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
Thank you Lynn
Your comments have gone viral across the hospital system
I don't think that most understand the concepts of "disinfection" and "antisepsis"
Your detailed description of applying alcohol to "clean" skin and scrubing until the last application was clean
raised the most eyebrows; as we were originally told that the CHG applicator would be substituted by ONE alcohol pad
Stay Tuned
Robbin George RN VA-BC