I work in a LTAC hospital in which we have had only 1 infection in the last 9 months until last month. We are calculating 3 blood stream infections and trying to look at all potential problems. My directorand an educator have looked at our IV tubing as a potential problem. We are currently using IV tubing by B.Braun---and my director and educator are wanting the staff to begin putting the clearmax plus valve on top of the built in ports (valves) on the IV tubing to give the nurses a flat surfaceto clean before entering the tubing. I understand their concept, but I am concerned about puttingone valve on top of another. If the valve/port built into the tubing is contamiated, the other valvewill keep the first one open and not working as a barrier.
I don't think adding another piece of equipment to the existing IV tubing will change the way thatthe nurses scrub the hub or not scrub the hub before entering the tubing. I agree that a flat surfacewill be better--so, why not look at new tubing?
what are your thoughts?
I totally agree with you. Adding a piece on top of another piece will not solve the problems. You also did not state whether you are using these tubings on continuous or intermittent infusions. How frequently are you changing the entire set? For continuous, you can extend that to 96 hours but for intermittent use, these sets should be changed every 24 hours, according to INS standards. CDC does not draw this distinction, however all studies of IV sets have been done on continuous sets, not intermittent sets. Manipulation of both ends of that tubing with each dose adds to the risk of contamination. How are the intermittent sets managed between uses? What dead end cap is placed on them? Or are they looping and connecting to a valve higher on the same tubing - nothing to support this practice either. So there are many issues with tubing that must be considered but I don't think their idea is the best approach. Lynn
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
We use Bbraun tubing and the max-plus clear. Look for a revised braun tubing (I'm told this fall), anyways, we keep our continuously connected tubing up for 96 hours, change our intermittent tubing every 24 hours incluiding TPN/lipids. Our infection rate is below the benchmark of 1.0 We also have in our policy and we continue to drill the point to scrub the connections with alcohol for 15 seconds but I can tell you that the compliance is poor.
For the few infections that we have had we perform a root cause analysis and also do a case study. I have presented a case on a unit and when I have asked if they have scrubbed the connections everytime for 15sec. I am told know. Also, frequently the tubings are disconnected. The organism that is grown is also an indicator as to how the infection occurred.
We do not and would not place the max-connector on the y-sites of the tubing.
Our policy is to change all tubing every 72 hrs---I am still trying to talk to the powers to be about the inter. tubing needing to be changed every 24 hrs. We do have end caps that are used to cap off the piggy back. yes, I still see tubing connected to itself. And, today, threw away inter. tubing that had an alcohol swab on the end of it!!! I havent' seen that in a while.
The 12cc syringes that we use no longer have a blue cap on the end of them--so, I am wondering if the nurses aren't noticing that the blue cap isn't there any longer and possibly contaminating the syringe before using it--whether it is drawing blood or giving meds.
Performing a root cause on these patients sounds like a great idea--because, I am VERY concerned about 3 infections in one month--when that hasn't been our norm.
Thanks--G.G.