anyone else out there have a policy requiring blood culture bottles be wiped off on the tops with alcohol wipes before use? and of course I'm talking about brand new, just opened bottles.
our hosp policy requires this, and I think it's an unneccessary step that adds manipulation to an already sterile area. amer college of path book I have from a few years ago doesn't call for this step at all.
just a little pet peeve I have to do (or feel really guilty about NOT doing!!) every day of my job :) !
If you're comfortable telling me where you work, that would help too. many thanks!
Specializes in Emergency, Critical Care (CEN, CCRN).
I was thinking the same thing (re: wiping the bottle tops with alcohol vs. chloraprep). Anyone know the reasoning?
Activity and expense. Neither isopropanol nor povidone-iodine solution have much residual activity beyond the initial microbe kill.* (Povidone-iodine is slightly better, but at least on skin, the difference is pretty much negligible.) There's also the consideration that alcohol kills bugs more or less instantly, while aqueous povidone-iodine solution needs to sit on a surface for a minimum of one minute to achieve any meaningful kill. Chlorhexidine-ethanol solution kills within 30 seconds and remains active for six hours and change on skin, which is wonderful if you're putting in a PIV or a central line - seal the site with a Tegaderm while the Chloraprep keeps killing underneath. (In our unit we usually draw the first culture and labs as we start the IV, so it's doubly worth it to use the good stuff.) In meta-analysis, the chlorhexidine solutions consistently outperform both alcohol and povidone-iodine, both in preventing CRBSI* and false-positive BCx from skin flora contamination.
However, for a culture bottle you don't need six hours of residual kill (it's a one-and-done injection, after which the bottle reseals itself), and chlorhexidine is a heck of a lot more expensive than either of the other two options. It doesn't make cost sense to use a second or third Chloraprep to do your bottles when Betadine and/or alcohol will work just as well.
* Caldeira D, David C, Sampaio C. (2011). Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. J Hosp Infect 77(3), 223-32.
* Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S. (2003). Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis 37(6), 764-71.
murphyle, BSN, RN
279 Posts
Activity and expense. Neither isopropanol nor povidone-iodine solution have much residual activity beyond the initial microbe kill.* (Povidone-iodine is slightly better, but at least on skin, the difference is pretty much negligible.) There's also the consideration that alcohol kills bugs more or less instantly, while aqueous povidone-iodine solution needs to sit on a surface for a minimum of one minute to achieve any meaningful kill. Chlorhexidine-ethanol solution kills within 30 seconds and remains active for six hours and change on skin, which is wonderful if you're putting in a PIV or a central line - seal the site with a Tegaderm while the Chloraprep keeps killing underneath. (In our unit we usually draw the first culture and labs as we start the IV, so it's doubly worth it to use the good stuff.) In meta-analysis, the chlorhexidine solutions consistently outperform both alcohol and povidone-iodine, both in preventing CRBSI* and false-positive BCx from skin flora contamination.
However, for a culture bottle you don't need six hours of residual kill (it's a one-and-done injection, after which the bottle reseals itself), and chlorhexidine is a heck of a lot more expensive than either of the other two options. It doesn't make cost sense to use a second or third Chloraprep to do your bottles when Betadine and/or alcohol will work just as well.
* Caldeira D, David C, Sampaio C. (2011). Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis. J Hosp Infect 77(3), 223-32.
* Chaiyakunapruk N, Veenstra DL, Lipsky BA, Sullivan SD, Saint S. (2003). Vascular catheter site care: the clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine. Clin Infect Dis 37(6), 764-71.