Are you asking about the new Joint Commission requirements? If so, your organization must have a written policy and procedure addressing the steps in disinfecting catheter hubs and needleless connectors. TJC does not provide any details of how to do this or what to include. But the main questions we are struggling with are:
1. what agent is best? 70% alcohol or chlorhexidine/alcohol combo Is the CHG necessary or does the alcohol in those products actually do the job. The Kaler study found that both were equal. Manufacturers of CHG products state their indication is for skin antisepsis, not object disinfection
2. cleaning technique - one swipe, scrubbing in multi directions, circular to cover top and sides, etc.
3. frequency - before each and every single connection? once at the beginning of a SASH procedure? Same cleaning pad or a new pad for each cleaning. SASH would mean use of 4 pads
4. length of cleaning time - 5, 10, 15, 30 seconds?
5. length of drying time
6. hand hygiene and use of clean gloves for this procedure
7. frequency for changing the needleless connector
Many of aspects have not been studied, so no evidence to support your decisions. This list contains all the factors I can think of but I may have forgotten something.Lynn
Yes I was asking about the JC statement and I thank you all for your responses I am aware of all the cap issues and we do currently follow the IFus for the product we use and that does fall in with what is currently being done,even though there is a lot of variation for all the reasons everyone has described. Our PICC team is awesome.....we just have a huge issue with compliance ...we are working on it though...what is really is ..is lack of knowledge of the nurses part as they do not realize how critical this step is and what I call "lack of respect for the VAD" and I mean any VAD.....with a lot of education they do better...so there is hope!!!!!..i was just trying to get if there was anything specific...Tx you all so much and I was just checking into the CHG cap scrub vs the alcohol and Lynn you answered it for me TX
what I call "lack of respect for the VAD" and I mean any VAD
I call it a cavalier attitude, about "that thing I have to use to get my meds out." I'm glad to hear there is hope! We are just in the infancy stage of trying to tackle this knowledge defict chasm.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Depending on the connector, a swabbing routine can be determined but one size will not fit all. Some connectors have been shown (menyhey,maki) not to be swabbable. First, if the manufacturer has a recommendation backed by laboratory testing then you can institute that as your procedure and evidence for the procedure. However, it is also part of the JC recommendation that you are able to prove that the nurses are doing this procedure and also whether this procedure has impacted CR-BSI outcomes. It will no longer be acceptable to say for instance that we require 30 second swab in hopes that the nurses will do 10 seconds or whatever. The swabbing procedure unfortunately will be tied to the connector that is being used. While 3-5 rotations or back and forth motions with alcohol is sufficient for one connector it will not be sufficient for another. It is my opinion, that draconian lenghts of time and the entire focus on nursing practice is misplaced. The reason for this issue is connector design. In the 80's before connectors, latex capts could be succesfully swabbed easily with alcohol. Different connector designs evolved during the 90's. Then in the past decade CR-BSI rates have climbed and connectors have been determined to be part of this problem. Nursing practice has been identified as the cause. We have accepted that the solution is in the confines of nursing. I believe that nursing must do its job but as Timsit, Jarvis and Maki have suggested, device design is a critical component of the problem and will also need to be a critical component of the solution. Until the linkage between practice and connector design is embraced, the outcomes that we all are looking for will not be fully achieved.
It is my understanding that you will have to show that the procedure is in fact being done as proposed. Also, since the reduction of CR-BSI to zero is the ultimate goal you will have to maintain clear records on CR-BSI rates and then if after you have instituted the swabbing procedure, met the threshold of procedure adherence by the nurses if this procedure had any impact positive or negative on the CR-BSI rate. The purpose of swabbing is to disinfect the entry point to the intraluminal fluid pathway. Strict adherence to procedures focused on protecting the intraluminal fluid pathway should have a positive effect on CR-BSI rates if in fact there had not been strict adherence in the past. There are many variables but Jarvis pointed out in his December CID article that if one thing is changed in practice and all other variables remain relatively the same then the change can be positively associated with the outcome.
Are you asking about the new Joint Commission requirements? If so, your organization must have a written policy and procedure addressing the steps in disinfecting catheter hubs and needleless connectors. TJC does not provide any details of how to do this or what to include. But the main questions we are struggling with are:
1. what agent is best? 70% alcohol or chlorhexidine/alcohol combo Is the CHG necessary or does the alcohol in those products actually do the job. The Kaler study found that both were equal. Manufacturers of CHG products state their indication is for skin antisepsis, not object disinfection
2. cleaning technique - one swipe, scrubbing in multi directions, circular to cover top and sides, etc.
3. frequency - before each and every single connection? once at the beginning of a SASH procedure? Same cleaning pad or a new pad for each cleaning. SASH would mean use of 4 pads
4. length of cleaning time - 5, 10, 15, 30 seconds?
5. length of drying time
6. hand hygiene and use of clean gloves for this procedure
7. frequency for changing the needleless connector
Many of aspects have not been studied, so no evidence to support your decisions. This list contains all the factors I can think of but I may have forgotten something.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
Yes I was asking about the JC statement and I thank you all for your responses I am aware of all the cap issues and we do currently follow the IFus for the product we use and that does fall in with what is currently being done,even though there is a lot of variation for all the reasons everyone has described. Our PICC team is awesome.....we just have a huge issue with compliance ...we are working on it though...what is really is ..is lack of knowledge of the nurses part as they do not realize how critical this step is and what I call "lack of respect for the VAD" and I mean any VAD.....with a lot of education they do better...so there is hope!!!!!..i was just trying to get if there was anything specific...Tx you all so much and I was just checking into the CHG cap scrub vs the alcohol and Lynn you answered it for me TX
what I call "lack of respect for the VAD" and I mean any VAD
I call it a cavalier attitude, about "that thing I have to use to get my meds out." I'm glad to hear there is hope! We are just in the infancy stage of trying to tackle this knowledge defict chasm.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
Depending on the connector, a swabbing routine can be determined but one size will not fit all. Some connectors have been shown (menyhey,maki) not to be swabbable. First, if the manufacturer has a recommendation backed by laboratory testing then you can institute that as your procedure and evidence for the procedure. However, it is also part of the JC recommendation that you are able to prove that the nurses are doing this procedure and also whether this procedure has impacted CR-BSI outcomes. It will no longer be acceptable to say for instance that we require 30 second swab in hopes that the nurses will do 10 seconds or whatever. The swabbing procedure unfortunately will be tied to the connector that is being used. While 3-5 rotations or back and forth motions with alcohol is sufficient for one connector it will not be sufficient for another. It is my opinion, that draconian lenghts of time and the entire focus on nursing practice is misplaced. The reason for this issue is connector design. In the 80's before connectors, latex capts could be succesfully swabbed easily with alcohol. Different connector designs evolved during the 90's. Then in the past decade CR-BSI rates have climbed and connectors have been determined to be part of this problem. Nursing practice has been identified as the cause. We have accepted that the solution is in the confines of nursing. I believe that nursing must do its job but as Timsit, Jarvis and Maki have suggested, device design is a critical component of the problem and will also need to be a critical component of the solution. Until the linkage between practice and connector design is embraced, the outcomes that we all are looking for will not be fully achieved.
Denise Macklin
Denise Macklin
It is my understanding that you will have to show that the procedure is in fact being done as proposed. Also, since the reduction of CR-BSI to zero is the ultimate goal you will have to maintain clear records on CR-BSI rates and then if after you have instituted the swabbing procedure, met the threshold of procedure adherence by the nurses if this procedure had any impact positive or negative on the CR-BSI rate. The purpose of swabbing is to disinfect the entry point to the intraluminal fluid pathway. Strict adherence to procedures focused on protecting the intraluminal fluid pathway should have a positive effect on CR-BSI rates if in fact there had not been strict adherence in the past. There are many variables but Jarvis pointed out in his December CID article that if one thing is changed in practice and all other variables remain relatively the same then the change can be positively associated with the outcome.
Denise