We are having a debate among nurses writing policies about cleaning caps with alcohol before each and every time a syringe or tubing is connected. Yes or no?One group believes:When you access a capped line and need to give a number of medications via 3 or 4 different syringes, you could clean with alcohol initially and not with the remaining syringes.The other group (venous access nurses) believes:You clean vigorously before each and every connection to a capped line.
We have reviewed the CDC Guidelines for the Prevention of Intravascular Catheter-Related Bloodstream Infections and have looked for research articles. The group supporting cleaning initially only don ‘t see that the CDC wording actually tells them "each time". They want to see it specified "each time" in references.
Anything you can offer would be appreciated.Gwen IrwinAustin, TexasÂ
Last summer I worked on a project to look at the method of cleaning reported to be used in a wide variety of studies. You will not find this level of detail in the process for cleaning needleless connectors or other injection ports. I strongly believe that this must be performed with each and every connection of every syringe or tubing. There can not be too much cleaning, so we must err on the side of patient safety. There is no published evidence either way.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Contamination of the
catheter hub contributes substantially to intraluminal colonization
of long-term catheters (23–25)
on p.5,
Clean injection ports with 70% alcohol or an
iodophor before accessing the system (164,235,236).
Category IA
p. 14 and
Minimize contamination risk by wiping the
access port with an appropriate antiseptic and
accessing the port only with sterile devices
(162,163,165). Category IB
p.15
Note: it says before " accessing the system", isn't each time you put a device (syringe, end of IV tubing) into a cap or valve "accessing the system"? That is how I interpret this. Also, it states to access a port with only sterile devices, once you use an alcohol wipe once, it is no longer sterile. This means a new alcohol wipe for every access, every time a syringe enters the system.
Hope this perspective helps you.
Chris Cavanaugh, CRNI
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
The authors of the article, "Strategies to Prevent Central Line-Association Bloodstream Infections in Acute Care Hospitals, discuss their recommendations for implementing prevention and monitoring strategies re: Cental Line-Associated Bloodstream Infections. Specifically they state, "Disinfect catheter hubs, needless connectors, and injection ports before accessing the catheter"(2008, p. S23-S25). Performance measures are also discussed and compliance of cleaning catheter hubs or injection ports prior to being accessed is recommeded to be visually monitored to obtain numerator data (# times hub/port observed being cleansed before being accessed) & denominator data (# times a catheter hiub or port is observed to be accessed). To get a compliance rate in percentage form, multiple by 100 (2008, p. S27).
Another article, "Keeping central line infection at bay" by the all famous Lynn Hadaway:) makes a terrific statement when discussing cleansing of the needless injection devices. She pointed out, "A simple but extremeley important step in preventing CR-BSI, regardless of the device design, is to throghoughly clean the injection surface of all needleless devices before each injection. She further states, "One wipe before the entire medication adinistration procedure isn't sufficient"(p. 62).
I follow Lynn's recommedations as I believe that hub truly is an extension of the vein, leading directly to the bloodstream; why wouldn't we wipe each time knowing as much as we do about microorganisms and especially about hub contamination.
Liz Holowasko BSN, RN, CRNI
References
Hadaway, L. (April, 2006). Keeping Central Line Infection at Bay. Nursing 2006. v 36, n 4.
Marshall, Mermel, Classes, Arias, Podgorny, Anderson, Burstin, Calfee, Coffin, Dubberke, Fraser, Gerding, Griffin, Gross, Kaye, Klompas, Lo, Nocolle, Pegues, Perl, Saint, Salgado, Weinstein, Wise & Yokoe. (October, 2008). Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals. Infection Control and Hospital Epdemiology. v 29, s 1.
Liz Holowasko BSN, RN, CRNI