Forum topic

for info about the Kaler - Chinn article, and other references/discussion about adequate disinfection of needleless connectors.

No, we all do not "know that the standard is 15 seconds". I am not quite sure if you are referring to any published set of standards or guidelines or some other method for establishing a "standard". To date there has been one single study - Kaler and Chin-  that arbitarily chose 15 seconds as the time to test. The researchers did not choose any other time intervals to test. The author has stated she chose 15 hoping that this would actually get 10 sec in clinical practice. This was a bench or lab study, not a clinical study. This study does not establish that the national standard should be 15 seconds. I have looked at all the studies on needleless connectors that I can find and assessed the language in each study for how they were cleaned. This one point has tremendous variation. I would strongly agree that this pump manufacturer is far off base to even suggest that 1-2 seconds is sufficent. I would mandate that they show me this in writing with adequate documentation to back up this claim. I applaud your efforts to stop this early in the process. We are all in a bad situation now with Joint Commission mandating a protocol for these details, yet there are not suffcient studies to establish what those protocols should be. If you have trained your staff on 15 seconds and you believe you are getting good compliance with that, I would continue, as this is your internal standard, But it is not a national standard, not yet anyway. Good luck with your efforts. Lynn

Thank you for your request for additional information concerning our recommended procedure for aseptic technique with the SmartSite^® valve directions for use including a 2 second swab 70% isopropyl alcohol with 30 second dry time.  A review of the Infusion Nursing standards of practice and CDC guidelines does not provide specific guidance or recommendations on timing required to swab an access port. 

In the CareFusion directions for use the recommended procedure is prior to every access, swab the top of the valve with 70% isopropyl alcohol for 1-2 seconds and allow to dry (approximately 30 seconds).  This recommendation is based on a microbial contamination study[1] which was conducted to demonstrate the capability of the SmartSite^® valve to resist bacterial contamination through the valve after repeated inoculations with Staphylococcus aureus.  The ability to effectively decontaminate the valve with 70% isopropyl alcohol using a 1-2 second swab and allowing the disinfectant to dry (for approximately 30 seconds) was also tested.   The results of the study show that no contamination was detected in the infusate for the 96 hour period. 

Various other manufacturers make recommendations to swab prior to access as well as some that identify a specific duration for disinfecting the access port. 

·          UltraSite Injection Site includes in the directions for use to swab the injection site for 3 seconds and allow to air dry prior to use per institutional protocol.[2]  

·          Maximus Medical Products, shares a study that they performed to ascertain whether the MaxPlus Positive Flow needleless valve, when microbiologically challenged over an extended (8-day) period of time, maintains a physical barrier to microbial contamination.  Within the reported test procedure the disinfection procedure was aggressive circular motion with pressure for 3 seconds).  The results show that when using a common disinfection protocol the MaxPlus connector did not increase the potential for microbial contamination.[3]

·          Baxter Clearlink System includes to swab luer activated surface with preferred antiseptic prior to first use and before every subsequent connection.[4]

“Alcohols have rapid bactericidal and mycobactericidal activity (e.g., 70% ethanol within 30s)[5]”.  Isopropanol, also a shorter chain alcohol, like ethanol, is widely used and is effective as an antiseptic and disinfectant.

We trust this information addresses your request for information. 

Sincerely,

Amy Edgett

CareFusion Sr. Product Manager

I do not believe that it is very real world for a nurse to allow alcohol to dry for 30 seconds prior to accessing the port. Alcohol does 2 things- it mechanically removes the bugs and also dehydrates them (that is why the alcohol has to dry).

I don't believe that alcohol needs 30 seconds of dry time.  I don't believe that the studies posted support this either.

Gwen Irwin

Austin, Texas

Connector disinfection is a hot issue. What is being understood is that it may be more complicated than just time and friction. Menyhey, Maki 2006 and Jarvis 2009 have discussed connector design as a factor related to microbial migration into the fluid pathway. In addition some manufacturers have recommendations which differ from product to product. The 15 second time frame is quite lengthy and when multiple entries are required this can be very hard to maintain compliance. Alcohol's biocide actvitiy occurs when wet, CHG with drying. A simple time limit may not be the answer. Denise Macklin

I believe the recommendation for alcohol dry time is just a recommendation of how long it may take for alcohol to dry depending on temperature and humidity. It can be different for each setting/location and a definitve amount of time cannot be stated that would work for everyone and every case. I wouldn't get hung up or focus on the drying time approximation recommended, but that they recommend allowing the alcohol to dry after swabbing.

Angelo,

The pathogen that was used in the study that was referenced is Staphlococcus aureus. 

Please let me know if you would like a copy of the white paper referenced.

Regards,

Amy

regarding   the cleaning of inj ports.. I wonder those who administer and so do the cleaning would make it the full 15sec if that injection port was connected to themselves. and find the time to let the alcohol dry.

 I have seen the best yet, recently I needed some IR attention and I presume it was the radiographer assisting, she prepared the vial of steroid for an intra-articular inj. she carefully took an alcohol wipe and sat it on the vial bung.. no rubbing just sat.. I guess that is what spiritual intervention is!! I demanded that she  rub the hub.. and she looked very  amazed. Yes I will be following it up with a letter of concern..

BUT with Lyn saying that no time has actually been defined by research, is it then best to aim for 15sec and accept 10 sec of friction.?? I  actually hum  a verse of Happy birthday.

So no I dont have any evidence, just keen to know what is the safe time zone, and thank you for asking

Brenda

I am looking for information on hub cleaning: alcohol vs chlorhexidine (are there any references for using/not using - I only find for skin prep).