Alcohol swabs and iv access ports - page 2

by luellamae

Does anyone know of any articles that state that it is ineffective to swab iv ports with alcohol. I have heard it both ways...always swab..then I've heard it isn't effective...any clues?... Read More


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    YES absolutely one should scrub (not swipe) catheter hubs (before cap changes)and needleless connectors(NCs) with either alcohol,chlorhexadine gluconate /alchohol combonation or tincture of iodine . It should be consistently and thoroughly done prior to each and every use. Both the catheter hub and the NCs are a known source for the development of catheter related bloodstream infections. To do otherwise is substandard care as this is clearly the standard of care based upon studies that prove this..now mind you, it is not the only way for bacteria to get in..but it is most definately a pathway. The actual time to scrub has not yet been determined due to limited studies on the matter. The one I see cited the most by the IV experts is the Kaler study.( Kaler W. Chinn R. Successful disinfection of needleless access ports: A matter of time and friction. Journal of Association of Vascualr Access 2007 12(3).
    They show that 5 seconds is not enough...10 is about right but they recommend 15 seconds. Time yourself b/c that 15 seconds is a lot longer then you think..I had to time myself several times before I got it right. It is best to use a product such as Site scrub IPA, a great product that allows you a no touch technique. I love this product. There has been a recent surge in products like these to better nursing care in this area and that is why you see new products like thses and others such as Curos that are caps that stay in place on the needleless connectors that are impregnated with IPA (alcohol). It also did not hurt that Medicare stopped paying as of Oct 2008 any central line associated bloodstream infections that the patient acquired while hospitalized and reducing catheter associated bloodstream infections got added to the national pt safety goals. So finally someone someone is paying attention to the issue.
    May I also point out the importance of making sure the caps (NCs get changed at least weekly) and the hubs need to be scrubbed as well. I see a lot of homecare patients return with an existing PICC where the Ncs NEVER got changed and bifilm can start to grow in them after just 5 days.
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    there is a really cool poster out there somewhere (we have them in our hospital but I've seen it online) that shows the difference on the hub under the bioluminecent light at 5, 10, and 15 seconds of scrubing. Its a great visual. I have read recently that the standard for central lines and piccs is 30 seconds. Even though my hospital only requires 15, I go the whole 30. I force myself to count every single time, never guess. I'm not going to be the one who gives a pt a central line infection if I can help it!


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