Our facility uses normal saline flush bags with a bag spike. This is a community bag and is changed q 4 days if not used up.  Is there any literature out there proving any contamination of these bags? The bag spike has a non reflux valve. I have never felt comfortable about this but have never read any studies. ThanksÂ
I would think that the "community" flush bag is being used like using a mult-dose vial and worry about the transmission of possibvle organisms. I do know but can't remember the article that was written about the transmission of Hep C with the use of mulit-dose vials. Does your hospital use multi-dose vials.
Helen Lazeration, CRNI
Fairbanks Memorial Hospital
Fairbanks, Alaska
Yes, there is plenty of data and this is a very dangerous practice that has received attention from MMWR and ISMP. Check my publications for a complete reference list:
1. Hadaway L. Flushing vascular access catheters: Risk for infection transmission. Infection Control Resources. 2007;4(2):1-8.www.infectioncontrolresources.org
2. Hadaway L. Technology of flushing vascular access devices. Journal of Infusion Nursing. 2006;29(3):137-145.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
MMWR - Morbidity and Mortality Weekly Report - government based
website - http://www.cdc.gov/mmwr/
ISMP - Institute for Safe Medication Practices - nonprofit organization devoted entirely to medication error prevention and safe medication use.
website - http://www.ismp.org/
Both well worth checking on.
MMWR - Morbidity and Mortality Weekly Report
ISMP - Institute for Safe Medication Practices
Incidentally, a bag of NS for IV administration is not a multidose container. It states on the bag that it is a SINGLE DOSE CONTAINER. That alone makes it a legal issue using it for multiple patients on the unit. When the pharmacist mixes things from a bag of fluid it is done under the pharmacy hood, to prevent contamination. Recall that this is a preservative-free solution. These are facts, not opinions.
Leigh Ann Bowe-Geddes, BS, RN, CRNI
Vascular Access Specialist
University of Louisville Hospital
Try these specific links re: transmission of infections due to contaminated multi-dose containers:
http://www.ismp.org/Newsletters/acutecare/articles/20000614.asp?ptr=y
http://www.ismp.org/Newsletters/acutecare/articles/19960717.asp
http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/375064&erFrom=3207957210814282175Guest
In the download section of this site you can find what I think is Lynn's reference bibliography. There is one article on the list that specifically mentions saline bags:
Cohen M. Intravenous bags as multiple-dose containers pose danger. Hospital Pharmacy. 1994;29:724-725.
I can't get at the article myself,but given the date I'm sure it won't specifically address anti-reflux valves for access. Even so,I'd say there is sufficient evidence showing the risks of contamination of multi-dose containers (be they vial,bottle,bag or whatever). Now,I'm sure your nurses use a new syringe every time they access one of theses bags,but can you guarantee that the valve connection is thoroughly cleansed each and every time a flush is drawn up? If not,there is your biggest contamination risk. Syringes are cheap,so are saline-filled syringes. BSI's are costly and dangerous. Why risk it? Good luck.
To pose a question or two.
Are you sure everybody accessing that "anti-reflux valve" is cleaning it before accessing? Or that nobody has reaccessed that valve with a dirty syringe? I don't care whose valve you are using, when disconnecting a little fluid is left on the end of the valve to promote bacteria growth. It is hard enough to get everybody to scrub the hub of catheters or valves that actually are connected to the patient.
it doesnt take a rocket scientist to see that this is bad practise. there also must be a lot of info out there about "single use". And 4 days?? Scary...
Rocket scientists use science. You have provided me with nothing more than opinion. How do you know that this is bad practice? The company that uses the Clave Anti-reflux valve guarantees their product, and I still have nothing to show my egotistical pharmacist or bean counting administrator. I'm sorry that you are scared, but I wonder if our rate of blood bourne infections is worse than yours. I've poured through the CDC literature and have found nothing. I'm quite surprised that a forum such as this has lots of opinion but little science.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Wendy Erickson RN
Eau Claire WI
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn for once again responding. I finally was able to obtain the article you wrote in Infection Control Resources. It was very good but with all due respect none of your references had anything to do with the Clave Bag spike made by ICU Medical.
Please correct me if I am wrong. The references you referred to had to do with multiuse bags accessed without using a bagspike with an antireflux valve. The two are very different. I can show these references to my administration and will, but I know they will want some studies using this product which your article just did not address. Thanks
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn, Your article in JAVA totally misrepresented this discussion. I am quite disappointed. This was about community flush bags WITH an antireflux valve, not without as you represented in your article. At this point I really can't take you seriously.
Our facility uses normal saline flush bags with a bag spike. This is a community bag and is changed q 4 days if not used up. Is there any literature out there proving any contamination of these bags? The bag spike has a non reflux valve. I have never felt comfortable about this but have never read any studies. Thanks
I would think that the "community" flush bag is being used like using a mult-dose vial and worry about the transmission of possibvle organisms. I do know but can't remember the article that was written about the transmission of Hep C with the use of mulit-dose vials. Does your hospital use multi-dose vials.
Helen Lazeration, CRNI
Fairbanks Memorial Hospital
Fairbanks, Alaska
[/quote]In FL we used to use the community bag. We also did a study culturing the bags and didn't grow anything. The policy was to use the umbrella spike, and to always replace the syringe used with a sterile one, so that it was always "capped". The problem I had with them was the frequency I found them "uncapped" on the units. I usually kept 'my' bag on my cart and only used the bag I spiked and monitored myself. The hospital has since switched to the single use flush syringes.
The One and Only campaign for safe injection practice clearly states that "community" flush bags are not good infection control practice. You can get posters to put up and brochures to share with colleagues at www.oneandonlycampaign.org
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
anything we can do to cut down on CRBSI
This dangerous practice of using large volume bags or multiple dose vials for catheter flushing solution must be stopped. I was at a CDC meeting a few days ago about this very issue. Since 1999, 125,000 people have been notificed of potential exposure to HBV, HCV, and HIV due to these bad practices, primarily in nonacute settings. Single dose flushing systems is the national standard of care. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am just astonished that this is even considered. Besides the so obvious: potential for contamination, single use issues and the fact that IV solution bags should not hang more than 24 hours. Just what are they thinking... if it is a $ issue - consider cost analysis of one infection, one law suit.
Ann Zonderman, BSN, JD, CRNI
I was a little stunned when I read this!!!! We have been using pre-fills since they first became available b/c of the nice but pushy IV team....and I mean that in a good way!!!!
There is a "One and Only Campaign" initiated by the CDC and Safe Injection Practices Coalition. Here is a link to a 10 minute video that they use and discuss community bags (and more) as unsafe.
http://blogs.hcpro.com/osha/2010/06/one-and-only-campaign-releases-safe-injection-practices-video/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+OshaHealthcareAdvisor+%28OSHA+Healthcare+Advisor%29
Gwen Irwin
Austin, Texas
The direct route to this site is http://www.oneandonlycampaign.org/default.aspx. This is a new inititative from CDC due to the fact that 125,000 people have been tested for exposure to bloodborne pathogens over the past 10 years. This exposure has primarily come from bad practices in non-acute settings such as doctors offices. A few weeks ago, I attended a meeting at CDC about this issue. It requires lots of education so please pass the word on this site. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Here is another story that just came across my emails. It does reference what we were discussing at this CDC meeting and the lax infection control procedures in non-acute settings. I heard an audiologist tell her story of being infected with hepatitis while receiving chemotherapy for breast cancer in the outbreak reported in Nebraska a few years ago. This outbreak was caused by the use of a community flush bag for all patients. Her and her family practice husband have their own website - http://www.honoreform.org/
Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861