Jul 19 by iluvivt
YES absolutely one should scrub (not swipe) catheter hubs
(before cap changes)and needleless connectors(NCs) with either alcohol,chlorhexadine gluconate /alcohol combination 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 definitely 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 these 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 home-care patients return with an existing PICC where the NCs NEVER got changed and biofilm can start to grow in them after just 5 days.
This is a repeat pf my recent post . The selected cleansing agents come from the current INS standard...Pm if any questions