Effectiveness of alcohol?? - page 3

A doctor recently told me that the alcohol prep pads we use before starting an IV or administering an injection are useless. He said there is no literature to support alcohol as an effective means of... Read More

  1. by   canoehead
    Running- I was about to say the same thing. If I wipe and get a clean spot sometimes I am lucky. I had a guy come back tonight after being seen last night and he still had the clean patch from last night's IVF visible on his arm.
  2. by   Nursonegreat
    semi off-topic....but what is going on with this...i have labs drawn a few times a year for my thyroid...it really seems that every time the phlebotomist wipes with alcohol prep then runs her gloved finger over my (bulging) vein to check where it is. the proceeds to insert needle. has anyone ever seen this?!?! i usually dont watch cause i hate the insertion of needle, but as i would turn away i noticed that i didnt feel a clean swipe after all the touching. next time i will have to catch them before insertion...but gosh, they must draw labs 100 times a day. anyone else seeing this?!?!?!?!?!
  3. by   KristiePDX
    So what about swabbing ports on IV tubing with prep pads? Is this too pointless? What about multiuse viles like insulin? Is this another thing we do because "thats how we always have done it"?

    I think I will continue to use prep pads until the hospital provides me with somthing better.
  4. by   Lady_in_red
    KristiePDX. Interesting questions. Another I wonder about...How long should that tubing or vial be wiped?

    So what I have found out about ChloraPrep is:
    ChloraPrep costs about $1 a piece. (NY hospital uses process, product, education to cut bloodstream infections, Healthcare Purchasing News, 2003)
    It is the preferred solution for catheter insertion by the CDC-but “tincture of iodine, iodophor, and 70% isopropyl alcohol can also be used” (CDC, 2002, p 16). Demonstrated higher efficacy compared to isopropyl alcohol with reduced colony-forming units over 5 days (Ryder, 2005)
    Mechanism of action: Denatures microbial proteins & disrupts cell membranes

    The actual rate of infection for catheter insertion is difficult to determine for peripherally inserted catheters
    Peripherally inserted catheter insertion is rarely associated with bloodstream infections-it's usually a PICC or midline

    I still haven't found any actual research studies supporting the use of alcohol wipes. There are a couple strong studies supporting the 2% chlorhexidine.

    So more questions-
    Is the expense of using ChloraPrep for all invasive procedures (blood draws, periphereal IVs, heel sticks) justified?
    Should it be used on all catheter insertions or just the PICC & midlines?
    Should all invasive procedures for immunocompromised patients be using ChloraPrep? or is alcohol good enough?

  5. by   jjjoy
    Hence, the problem with "evidence-based" practice. Of course, we want to keep up to date on the latest research and we should adjust and update our practice based on new, proven findings. I hope everyone's been doing that over the years regardless. However, for many practices, the evidence-base simply isn't that strong one way or another yet we've still got to choose one practice over another. I think on the one hand we need to be open to new information to inform our practice and on the other hand we need to be patient with the slow rate of evidence production, dissemination and change of practice. Also, much research is done in isolation, not in a real world setting, where competing priorities and pragmatic issues mean there are many other variables not accounted for in the research we use as a evidence base.
  6. by   Spidey's mom
    I was taught the iodine wipe, let it dry and then alcohol when I was in school 10 years ago.

    But seriously - in the ER it is kinda hard to be patient and let that iodine dry prior to IV insertion . . . . on a busy med/surg floor I can see it would be hard to wait too.

    As to the post about the alcohol wipe being black with dirt - the one instance that stands out for me is the 8 y.o. boy in for fracture who lives in a hovel w/o running water and had not had a bath in . . . who knows how long. Sad.

    steph
  7. by   chris_at_lucas_RN
    This came up last year on this board, and I remember being rather appalled to find out that in other developed nations (mostly Commonwealth), only the "socially unclean" got the alcohol wipe, others just got stuck.

    Supposedly there was no difference in the incidence of nosocomial infections, etc., but I guess it is what I am used to, because for once, research didn't reassure me one bit.

    I think the issue with alcohol is that it will not leave behind an antimicrobial residue the way the phisohex types and betadine types do. For some tasks, we sure want a strong barrier, or if we are working in an area particularly likely to have lots of bacteria (thinking of cath preps now).

    But if the stick is quick, all we need to do is clean the area, get it done and exit.

    And socially clean or otherwise, if it reduces the likelihood of infection--even if it is only in the mind of the patient--who are we not to use something for a prep.

    I guess soap and water would be good as well, but messy and maybe a teense more expensive.

    JMO.....
  8. by   Spidey's mom
    Quote from chris_at_lucas_RN
    This came up last year on this board, and I remember being rather appalled to find out that in other developed nations (mostly Commonwealth), only the "socially unclean" got the alcohol wipe, others just got stuck.

    Supposedly there was no difference in the incidence of nosocomial infections, etc., but I guess it is what I am used to, because for once, research didn't reassure me one bit.

    I think the issue with alcohol is that it will not leave behind an antimicrobial residue the way the phisohex types and betadine types do. For some tasks, we sure want a strong barrier, or if we are working in an area particularly likely to have lots of bacteria (thinking of cath preps now).

    But if the stick is quick, all we need to do is clean the area, get it done and exit.

    And socially clean or otherwise, if it reduces the likelihood of infection--even if it is only in the mind of the patient--who are we not to use something for a prep.

    I guess soap and water would be good as well, but messy and maybe a teense more expensive.

    JMO.....
    I like the soap and water idea . . . certainly faster than watching that iodine dry . . .

    steph
  9. by   chris_at_lucas_RN
    Quote from stevielynn
    I like the soap and water idea . . . certainly faster than watching that iodine dry . . .

    steph
    That's what they use to start a line for blood donations, and it dries pretty quick--they do put a 2 x 2 on it (I assume to keep other stuff out of it), and by the time they get the pipe (it's too big to be considered a needle!) unsheathed, the betadine is dry.

    Hurts like a stinker though--it seems to make the needle drag more--the skin seems sticky (from a consumer's perspective).

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