Forum topic

The Kaler article is what everyone is using. To my knowledge there are no other similar studies that have looked at this. Unfortunately the Kaler study did not assess a shorter time period. I have heard Dr. Maki at various presentations state that 10-15 seconds should be what is used. Sorry, this is what we have to work with right now. I would also hasten to emphasis that cleaning is a critical component, so please do not back down on your emphasis of this important step in eliminating CRBSI. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

 Did you check out the discussion in other forum threads - Kaler being one of the search options?

New research is on the way!  I have been in progress for the last 2-3 yrs with a program of research on a new disinfection device designed to disinfect injection ports, needleless connectors, catheter hubs, and stopcocks.  This research will be presented in the poster session at SHEA this month.  Further research is in progress.

While access site disinfection may seem relatively simple, there are actually multiple variables that play into the complete eradication of organisms on a surface and within catheter hubs or stopcocks.  These include the disinfecting agent, the concentration of the agent, the volume of the agent, the contact time (dependent on the first three), the method of application, and the innoculum of microorganisms (even more difficult to eradicate if in biofilms). All have to work together!

Kaler's study demonstrated success with a 15 sec application (measured by flush through), however this was with only an innoculum of 2 log of bacteria (>100cfu, <1000 cfu) on the connector surfaces, some of which have low bacterial tranfer rates (FDA requires minimum 3 log measure for ingress testing for needleless connectors, now requiring 4 log reduction for antimicrobial treated connectors).  It may take longer for eradication when higher innoculums are present, which based on the literature is usually the case. Based on my findings of extensive biofilms on connectors retrieved from patient connectors in an ICU (poster presented at APIC 2008) we are dealing with fairly high innoculums (within biofilms). 

Kaler did not indicate drying time.  Alcohol prep pads do not leave much residual and dries quickly but CHG prep pads are very saturated (a very good thing as they are designed for skin antisepsis). I have found a visible volume of CHG left on the Smart Site Plus and the UltraSite after use of the CHG prep pads which takes up to 2 minutes to dry. This is probably of no consequence in adults? but may be in neonates (I will be evaluating this as well)

Also remember that the site of colonization associated with risk for bloodstream infection in catheter hubs and stopcocks is in the internal surfaces of the hub and not the outside threads (although good to clean this area as well, especially if blood is present.  It is virtually impossible to disinfect the inside of a catheter hub or stopcock with a prep pad.  How would you do that?  You would probably contaminate it in the process especially since you automatically contaminate both sides of a prep pad on removal from the package touching both sides.  Catheter hub disinfection protocols are (and stopcock disinfection should be) a requirement of the Joint Commission (thank goodness as this is a missing link to getting to zero for CRBSI) as well as a SHEA/IDSA recommendation.

Happy to share the poster after presentation at SHEA if there is interest.

Marcia Ryder

Dear Cheryl and Dee Dee,

 I have attached the poster as requested.  It has been reformated into pages so that it is easy to print out and read.  Happy to address any questions you may have.

Next level research is ongoing.

Marcia Ryder

Kathy Kokotis

Bard Access Systems

Marcia thanks for sharing the research.  We are going to see a huge change in this market this year and next.  With new swab solutions and new caps

kathy