Proper cleaning using alcohol wipes

iluvivt, BSN, RN · Aug 26, 2012

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

knitsocks77 · Aug 26, 2012

I don't have an evidence-based response for you but I always use a new alcohol wipe. They dry out so quickly that I think it would be difficult to get more than one use from a single wipe. If you scrub a hub for 15 seconds that wipe is probably almost dry. I work at a clinic where I administer a lot of injections. Sometimes I have to use 2 or more alcohol wipes before giving an injection because the wipes are visibly soiled after the first swipe.

npatte1071 · Aug 26, 2012

I want to give you an answer, but the instructor in me says to Boolean in the school library database for the answer.

Natali L Patterson, MSN, RN

Double-Helix, BSN, RN · Aug 26, 2012

If you're following the standard 15 second scrub and 15 second dry time before accessing the port, I find it hard to believe that an alcohol wipe would still be sufficiently wet enough to remove bacteria for a second 15 second scrub. Not after over a minute has likely elapsed between uses. Not to mention the fact that, unless you keep your eye on that swab the entire time you're giving the medication, you can't be sure that it wasn't contaminated.

Alcohol wipes are sterile in the package. Once they are removed, the sterility is compromised. If I were really concerned about removing bacteria, I would not re-use an alcohol wipe.

You should always check the policy at your facility, however. At my facility, if we are accessing a port or hub for a one-time use, such as giving a med IVP and then flushing, we do not need to re-scrub the hub between removing the medication syringe and attaching the flush, as long as we have been present the entire time and can ensure that nothing has touched the hub except the sterile syringes.

malestunurse · Aug 26, 2012

I would look up from the manufacturer long the wipes claim to be effective for.

bluewillow7 · Aug 26, 2012

In Nursing School, was taught one wipe used once, wiping down and not going back..have been out of nursing for some time, but see home care patients who are diabetic recieveing through the mail, their supplies, which are coming from China, and wipes are smaller than the nail on your thumb, can barely grasp it..and even hospital beds in homes, made cheaply and not functional to meet patient need if for example feet need elevation..it raise to less than half of normal..garbage..needs investigation into this homecare area..obviously check to see where product is coming from..usually no info on package etc if from China..

Pediatric Critical Care Columnist · Aug 26, 2012

Chlorhexidine gluconate has a duration of antimicrobial activity that is 5-6 hours from the time of application and it retains this activity in the presence of blood and other organic material. This would imply that as long as a swab remains wet, a chlorhexidine-IPA saturated swab should be reusable.

beth66335, BSN, RN · Aug 26, 2012

I use achohol pads to clean ports and hubs one time. Also, always remember to open the clamp before you scrub to make to port "pop" out slightly for better contact with the pad...I also sing Happy Birthday in my head while I scrub to ensure enough scrub time and wipe around the outside of the cap at the end too...I don't, however, scrub again after the flush...if you don't touch the end of a syringe when drawing up a medication, it is still sterile enough to connect to the port without a second scrubbing...

KiyaRN · Aug 26, 2012

Thank you all for your feedback!! I have seen many articles on the caps that are being used and I think it's a great idea, although I would personally still feel the need to scrub with alcohol. I will be singing Happy Birthday and using new wipes each time I need to clean a port! And I have tried using my school's online journals, but I am in a community college and our selection is not exactly large. (For the record, my instructor advised that she wipes the port, then she will lay the wipe on the patient's arm underneath the port.)

Thanks again!! And if anyone happens to stumble upon any EBP sources I would love to review them!

iluvivt, BSN, RN · Aug 30, 2012

alcohol pads are a one time use..some of the CHG products are marketed as ONLY to be used on skin and not medical devices so check the manufactures recommendations