Do not be fooled by what the 2011 CDC Guidlelines actually say as some are trying to put a spin on it.
The exact wording of the 2011 CDC Guidelines is: "Chlorahexidine Impgregnated Sponge dressing IF the rate of infection is not decreasing despite adherence to other strategies (ie., education and training, maximal sterile barrier precautions, and >0.5% chlorahexidine preparations with alcohol for skin antisepsis)" page 8 from the CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011.
The truth of the matter is that the CDC DOES NOT endorse any company or a specific product here. Some people seem to think this is an endorsement for Biopatch. It Is Not.
The use of the word IF is the key word in these 2011 CDC guidelines which makes this recommendation a UN-RESOLVED ISSUE according to the CDC, not a category 1B as some people seem to think it is.
It is correct that the CDC does not endorse any company or speicific product. The CDC does recommend best practices based on published evidence.
I seem to read the Guidelines differently. To me, "if" does not mean un-resolved issue. What is categorized as an un-resolved issue is the use of " other types of chlorhexidine dressings."
"12. Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age if the CLABSI rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorhexidine for skin antisepsis, and MSB [93, 96–98]. Category 1B
13. No recommendation is made for other types of chlorhexidine dressings. Unresolved issue"
Tim Royer BSN CRNI VA-BC
Does the product made by silverlon address this issue
No definitely not. There is no published research to my knowledge about silver used for these types of dressings. CDC does not include silver dressings at all in their statement. Usually when there is no evidence at all, the CDC is silent. You may find white papers from a variety of manufactuers, however those papers are published by the company for marketing purposes. They have not been through any level of peer-relview process as when a study is published in a journal. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Biopatch most certainly meets the 2011 CDC guidelines as a CHG impregnated sponge. The CDC is not trying to "fool" anyone. The committe makes recommendations based on evidence- if you look at the studies reviewed to make this recommendation, they are Biopatch studies. It is true that the CDC cannot endorse one specific product- but look at the evidence, it's all there: www.biopatch.com
Doesn't the INS Standard 51.2 say that "Catheter site care Shall ALLOW for Observation and Evaluation of the Catheter-Skin Junction and Surrounding Tissue"? If so, how in the world could the Biopatch do this as it is occlusive. You cannot see the Catheter-Skin Junction without lifting the patch.
Also it is complete non sense to think that some products lay perfectly flat in contact with this skin all the time thus allowing areas to receive no chg thus no protection. CHG has to be in contact with the skin to work.
Also INS Standard 56 Infection Practice, Criteria E Says: "Catheter Insertion Sites should be observed for redness, edema, induration, temperature changes and drainage."
Clearly VISIBILITY is a requirement of standards and you do not get this with the Biopatch. Besides if Biopatch is so wonderful, why have they never been able to disprove the efficacy of other products like Tegaderm CHG?
L. Puckett
As INS members, we infusion nurses are aware that the organization as a whole does not do "commercials" for certain products. They base their recommendations as standards of practice. These standards serve as a guide for implementation towards the goal of quality patient outcome. It is the patient at the center of their methodology. The INS supports the use of evidence-based strategies to affect these outcomes, and clearly Biopatch fits the bill.
The comment regarding CHG efficacy related to skin contact is absolutely right. It is known that CHG cannot transfer, suppress colonizaton, and subsequently decrease risk where it is not in contact with the skin. This is what makes Biopatch so effective in comparison to some competitors. Circumferential protection at the insertion site is certainly a superior design to that which lies on top of the catheter, thus allowing for gaps in coverge and gaps in efficacy.
As far as visibility, one need only look at the CDC's recommendations for site visualization at dressing change as well as their definition of clinical exit site infection to realize that Biopatch use will not interfere with this assessment. In addition, inflammation at the site is not indicative of infection. Many lines have been pulled unnecessarily due to hasty judgements secondary to a visual cue. More importantly though, nurses do have critical thinking ability. We use our judgement every day and apply our experience and skill to advocate for our patients. Relying soley on one assessment tool is a novice approach. We of course consider the whole picture and use all of our skills and knowledge at hand before acting on our patient's behalf.
Speaking as an experienced nurse, I have comfort and confidence in my judgement and competence. I go with that- and the evidence...I can't go wrong.
Unfortunately Many continue to place the Biopatch on wrong. We see it Left Off Entirely, Put On Upside, Not put on In Contact with the Skin. Any of these conditions leads to Limited at best or No Protection for a patient. I suspect this happens 30 to 35% of the time and CRBSI's are partially the result of it.
Several hospitals now have independent comparision studies between multiple products and most show that there is a more effective way to reduce infections than total belief in the Biopatch. The Issue remains Incorrect Placement which happens a lot more than people seem to realize. No matter how much education one does, Biopatch still will be Left off, Put On Upside Down and Not placed Flat on the Skin so areas will Not Be Protected. There is no way if can provide 360 degrees of protection if Any of these happen
Clearly Visibility is important also or the INS guidelines would not call for inspection of the site. Biopatch does interfere with assessment as one has to lift it to see the site. An infection could be going on underneath it that has not yet been seen. One also needs to remember that the Biopatch studies were NOT done with a CHG scrub but rather Iodine. This is a huge point as most use CHG to prep the skin before IV placement. Also Biopatch came to market a long time ago and Newer Technologies are proving just as if not more effective. If I am correct, their CRBSI study took more than 6 years to be done.
If one only uses the CDC as their only source of information on this subject, they are simply missing the boat as you need to look at multiple clinical reference sources to see the whole picture. The CDC is just a roll up of data that has been published and in this case references clinical information done in 1996 and before.
Just because you are taught one thing doesn't mean things do not change or that there isn't something better out there so be open minded.
From the CDC: "Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age IF the CLABSI rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorhexidine for skin antisepsis, and MSB [93, 96–98]. "Category 1B
With regards to the above statement, either you are Above the National Average for CRBSI and need to use some kind of antimicrobial protection or you are below the national average and what you are doing is working.
That is why the word "IF" is in the statement from the CDC. No one should interpret this statement any differently and even then, the CDC did not mean to be product specific in this recommendation. Blind use of a chlorhexidine-impregnated sponge is absurd when other products are also worthing looking at.
Additionally please take a close look at all the studies published on this matter that the CDC referenced such as Ho/Litton and others. CHG Preps were NOT used in the studies as part of the bundle. Provodine Iodine was used in all the studies and everything referenced by the CDC is published in 2006 or before before other products were even on the market.
So ask yourself Are you in the group whose CRBSI infection rate is Above the National Average and you need to use an Antimicrobial or are you in the group below the National Average and what you are doing is working before you introduce a chlorhexidine-impregnated sponge dressing.
The logic of "We are below the national average so it's working" is troublesome to me. Compared to other developed countries the United States has an atrocious record of pt. safety, and it is this type of thinking that perpetuates poor outcomes. Shouldn't we as front line pt. advocates be fighting for each pt.? The idea that some infections are ok based on a under-reported statistic from the CDC should be repulsive to all nurses. Especially when so many facilities have achieved a zero rate for extended periods of time!! New technologies which assist in eliminating preventable hospital deaths are like endangered species. Everyone wants to save the eagle and polar bear but what about less glamorous species? Hospitals jump at a DaVinci system or the latest PET scanner, but some the less glamourous items may save more lives!
Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness
It is correct that the CDC does not endorse any company or speicific product. The CDC does recommend best practices based on published evidence.
I seem to read the Guidelines differently. To me, "if" does not mean un-resolved issue. What is categorized as an un-resolved issue is the use of " other types of chlorhexidine dressings."
"12. Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age if the CLABSI rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorhexidine for skin antisepsis, and MSB [93, 96–98]. Category 1B
13. No recommendation is made for other types of chlorhexidine dressings. Unresolved issue"
Tim Royer BSN CRNI VA-BC
The point that is being overlooked, even by CDC, is that all infection risk does not originate in the skin. All anti-infective dressings will only address the skin as the source of the infection. During the first week of dwell the extraluminal side of the CVC has more biofilm and thus the attention to the skin. After that, there is much more biofilm on the intraluminal side. So use of these dressings without ways to reduce the intraluminal risk will not get you to zero infections. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
For years this matter has been an Unresolved issue. IF it is not now still a Unresolved Issue, then what is it? It certainly does not fit any other category. Go back and compare other CDC recommendations to the 2011 ones and you will see the point.
I really think one certain company is trying to spin these recommendations in their favor when the CDC clearly does not come right out and say that is is a 1A recommendation. It has never been even a 1B either. Zero in fact may be unobtainable because Lynn is correct. Not all infections begin on the skin.
Those who think these CDC guidelines indicate use of Only one product (biopatch) are mistaken because the CDC does know of other products on the market and if they intended for this to be a 1A or 1B recommendations, they would have written it that way. As it stands now, it remains a Un-Resolved issue.
Silver as I understand it is for wounds, not IV sites. Some people obviously use it but CHG is the standard for anti-microbial infections. Why anyone would use Silver for an IV Site is beyond me.
Puckett
I agree with Stephen. Below or above average is no longer the appropriate way to approach any infection, especially CRBSI. There is no reimbursement for treatment of any hospital-acquired CRBSI, and therefore the goal is zero, 0, zip, nada, however you want to say it. There are several studies showing that this goal is acheivalbe. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861