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37 posts / 0 new

Fri, 04/13/2007 - 08:36

allenmob

community flush bags -

Our facility uses normal saline flush bags with a bag spike.Â This is a community bag and is changed q 4 days if not used up. Â Is there any literature out there proving any contamination of these bags?Â The bag spike has a non reflux valve.Â I have never felt comfortable about this but have neverÂ read any studies.Â ThanksÂ

I would think that the "community" flush bag is being used like using a mult-dose vial and worry about the transmission of possibvle organisms.Â I do know but can't remember the article that was written about the transmission of Hep C with the use of mulit-dose vials.Â Does your hospital use multi-dose vials.

Helen Lazeration, CRNI

Fairbanks Memorial Hospital

Fairbanks, Alaska

Fri, 04/13/2007 - 09:49

lynncrni

Yes, there is plenty of data

Yes, there is plenty of data and this is a very dangerous practice that has received attention from MMWR and ISMP. Check my publications for a complete reference list:

1. Hadaway L. Flushing vascular access catheters: Risk for infection transmission. Infection Control Resources. 2007;4(2):1-8.www.infectioncontrolresources.org

2. Hadaway L. Technology of flushing vascular access devices. Journal of Infusion Nursing. 2006;29(3):137-145.

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

Sun, 04/15/2007 - 12:38

(Reply to #2) #3

allenmob

what is MMWR and ISMP?

Sun, 04/15/2007 - 16:04

(Reply to #3) #4

Timothy Royer B...

MMWR - Morbidity and

MMWR - Morbidity and Mortality Weekly Report - government based

website - http://www.cdc.gov/mmwr/

ISMP - Institute for Safe Medication Practices - nonprofit organization devoted entirely to medication error prevention and safe medication use.

website - http://www.ismp.org/

Both well worth checking on.

Fri, 06/04/2010 - 15:58

(Reply to #4) #5

Leigh Ann Bowegeddes

MMWR - Morbidity and

MMWR - Morbidity and Mortality Weekly Report

ISMP - Institute for Safe Medication Practices

Incidentally, a bag of NS for IV administration is not a multidose container. It states on the bag that it is a SINGLE DOSE CONTAINER. That alone makes it a legal issue using it for multiple patients on the unit. When the pharmacist mixes things from a bag of fluid it is done under the pharmacy hood, to prevent contamination. Recall that this is a preservative-free solution. These are facts, not opinions.

Leigh Ann Bowe-Geddes, BS, RN, CRNI

Vascular Access Specialist

University of Louisville Hospital

Mon, 04/16/2007 - 01:17

allenmob

Went to MMWR and ISMP.

Went to MMWR and ISMP. To be honest, there were several articles about contaminated pre-filled syringes but I could find nothing about multi-use community normal saline flush bags. To get to Lynns articles I would have to pay $21.50 to INS Guess I will remain in the dark.

Mon, 04/16/2007 - 02:27

DML RN

Try these specific links re:

Try these specific links re: transmission of infections due to contaminated multi-dose containers:

http://www.ismp.org/Newsletters/acutecare/articles/20000614.asp?ptr=y

http://www.ismp.org/Newsletters/acutecare/articles/19960717.asp

http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/375064&erFrom=3207957210814282175Guest

Mon, 04/16/2007 - 12:44

(Reply to #7) #8

allenmob

Thanks you, however these

Thanks you, however these articles are related to multidose vials not flush bags with an anti-reflux valve. Does anyone else out there use this practice or stopped due to infection risks?

Tue, 04/17/2007 - 03:01

allenmob

Have not been able to find a

Have not been able to find a single article related to multidose flush bags with anti-reflux valve. Was hoping to find ammunition to present to my administration and arrogant pharmacy but they may be right. There seems to be no literature out there.

Tue, 04/17/2007 - 03:37

#10

DML RN

In the download section of

In the download section of this site you can find what I think is Lynn's reference bibliography. There is one article on the list that specifically mentions saline bags:

Cohen M. Intravenous bags as multiple-dose containers pose danger. Hospital Pharmacy. 1994;29:724-725.

I can't get at the article myself,but given the date I'm sure it won't specifically address anti-reflux valves for access. Even so,I'd say there is sufficient evidence showing the risks of contamination of multi-dose containers (be they vial,bottle,bag or whatever). Now,I'm sure your nurses use a new syringe every time they access one of theses bags,but can you guarantee that the valve connection is thoroughly cleansed each and every time a flush is drawn up? If not,there is your biggest contamination risk. Syringes are cheap,so are saline-filled syringes. BSI's are costly and dangerous. Why risk it? Good luck.

Tue, 04/17/2007 - 13:45

#11

allenmob

Surprisingly, there is more

Surprisingly, there is more written about contaminated individually wrapped syringes than multiuse flush bags. The pharmacy and administrations argument is that it is so much cheaper. Without any proof I have to conclude that they may be right. A 1994 article before antireflux valves 'aint going to do it.

Tue, 04/17/2007 - 20:07

(Reply to #11) #12

Timothy Royer B...

To pose a question or

To pose a question or two.

Are you sure everybody accessing that "anti-reflux valve" is cleaning it before accessing? Or that nobody has reaccessed that valve with a dirty syringe? I don't care whose valve you are using, when disconnecting a little fluid is left on the end of the valve to promote bacteria growth. It is hard enough to get everybody to scrub the hub of catheters or valves that actually are connected to the patient.

Tue, 04/17/2007 - 20:34

(Reply to #12) #13

allenmob

Hey, you are preaching to

Hey, you are preaching to the choir here. However with bean counting pharmacists and paper pushing administrators one must have hard evidence and I have yet to see any. I have no doubt that it is bad practice but WHERE IS THE SCIENCE?

Tue, 04/17/2007 - 21:54

(Reply to #13) #14

Timothy Royer B...

I do agree, we need more

I do agree, we need more science.

Thu, 04/19/2007 - 23:46

#15

sesymons

it doesnt take a rocket

it doesnt take a rocket scientist to see that this is bad practise. there also must be a lot of info out there about "single use". And 4 days?? Scary...

Fri, 04/20/2007 - 09:24

(Reply to #15) #16

allenmob

Rocket scientists use

Rocket scientists use science. You have provided me with nothing more than opinion. How do you know that this is bad practice? The company that uses the Clave Anti-reflux valve guarantees their product, and I still have nothing to show my egotistical pharmacist or bean counting administrator. I'm sorry that you are scared, but I wonder if our rate of blood bourne infections is worse than yours. I've poured through the CDC literature and have found nothing. I'm quite surprised that a forum such as this has lots of opinion but little science.

Mon, 04/23/2007 - 15:21

(Reply to #16) #17

lynncrni

If you have not found the

If you have not found the reports of nosocomial BSI outbreaks associated with this practice, then you have not looked at the reference list on the 2 articles I referenced in the early responses to your original question. Yes, there are numerous outbreaks reported and in 2003 MMWR issued a statement firmly stating Do Not do this practice. 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

Tue, 04/24/2007 - 05:43

(Reply to #17) #18

allenmob

I have tried several times,

I have tried several times, can't get to them. Why is nothing else out there?

Tue, 04/24/2007 - 09:05

(Reply to #18) #19

Wendy Erickson RN

I don't know about the rest

I don't know about the rest of you, but if Lynn Hadaway tells me that a practice shouldn't be done, I WOULD NOT do it! I consider Lynn to be one of the top PICC nurses in the world, and her research is considered top of the line, all of the time. If you want more research and there isn't any more out there other than Lynn's or what she references, then it probably doesn't exist. You'll need to do it yourself. If you can't "get to them", ask your library to get you copies of them.

Wendy Erickson RN
Eau Claire WI

Wed, 04/25/2007 - 00:57

(Reply to #19) #20

allenmob

I don't doubt that Lynn

I don't doubt that Lynn Hadaway is a very good PICC nurse and very knowledgable. But I can't really go to my administration and say, "Lynn Hadaways says what you are doing is vewy vewy bad and you should not do it." They really don't know who she is and frankly don't care. But I have searched the CDC website and can find nothing. The company that makes the Clave antireflux valve guarantees their product. Therefore I think if one dogs their product they should have some proper research.

Wed, 04/25/2007 - 07:39

(Reply to #20) #21

lynncrni

Again, the list of

Again, the list of references you are seeking can easily be found in those articles I have written and listed on my very first reply to your message. You locate those articles by going to your hospital library and asking the help of the librarian to get them through an interlibrary loan. Or you can usually purchase them online by going directly to the publishers website. Or you can request them to be faxed to you by placing an order through www.cinahl.com. You really have no excuse to not locate the articles, but doing a Google search is not enough. I would never encourage anyone to use my name as a reference for deciding clinical practice, but I have done thorough literature searches, found the information you need and published it in a peer-reviewed journal. Just do more homework to find what you need. 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

Thu, 04/26/2007 - 03:07

(Reply to #21) #22

allenmob

Thank you Lynn for once

Thank you Lynn for once again responding. I finally was able to obtain the article you wrote in Infection Control Resources. It was very good but with all due respect none of your references had anything to do with the Clave Bag spike made by ICU Medical.

Please correct me if I am wrong. The references you referred to had to do with multiuse bags accessed without using a bagspike with an antireflux valve. The two are very different. I can show these references to my administration and will, but I know they will want some studies using this product which your article just did not address. Thanks

Thu, 04/26/2007 - 08:07

(Reply to #22) #23

lynncrni

I took the liberty of using

I took the liberty of using this discussion and your question as the basis for my Catheter Connection column that appears in the next issue of JAVA. So I reviewed the literature last night. I found 5 published reports from 1993 thru 2004 of bacteremia outbreaks directly linked to this practice of using a common bag as the source of flush solution for many patients. At least one study was using an anti-relfux valve on the bag. I do not think you will find a study using the specific brand you mentioned. I still say this practice is dangerous and is outside the recommendations from CDC, INS, JCAHO, and MMWR. I also found a report in MMWR with a specific statement of Do Not do this practice. I do not have any faith in an antireflux valve to prevent contamination of these fluids. What have you seen to prove that this particular bag spike is safe for use? If you are seeing only white papers from the manufacturer, that would not be enough to support this practice in light of the evidence of these reported outbreaks. 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

Thu, 04/26/2007 - 16:17

(Reply to #23) #24

allenmob

I have seen nothing to prove

I have seen nothing to prove that this is safe for use except what the manufacturer states. I do not support this practice not only because I don't trust the anti-reflux valve but I don't like the fact that the spike is accessed again and again over 4 days! (It has to be filthy!) It's just I have no say at the facility I work at and without evidence they will not listen to me (Not that they will anyway). I appreciate you taking the time.

Sat, 07/21/2007 - 14:36

(Reply to #24) #25

allenmob

Lynn, Your article in JAVA

Lynn, Your article in JAVA totally misrepresented this discussion. I am quite disappointed. This was about community flush bags WITH an antireflux valve, not without as you represented in your article. At this point I really can't take you seriously.

Fri, 04/27/2007 - 08:18

#26

Linda C Motley

Perhaps you could get your

Perhaps you could get your lab to do some cultures...the spike, the fluid in the bag, the fluid in a syringe, etc.......evidence based conclusion could then be drawn.

Tue, 05/22/2007 - 07:05

#27

rayedillon

[quote=allenmob] Our

[quote=allenmob]

Our facility uses normal saline flush bags with a bag spike. This is a community bag and is changed q 4 days if not used up. Is there any literature out there proving any contamination of these bags? The bag spike has a non reflux valve. I have never felt comfortable about this but have never read any studies. Thanks

I would think that the "community" flush bag is being used like using a mult-dose vial and worry about the transmission of possibvle organisms. I do know but can't remember the article that was written about the transmission of Hep C with the use of mulit-dose vials. Does your hospital use multi-dose vials.

Helen Lazeration, CRNI

Fairbanks Memorial Hospital

Fairbanks, Alaska

[/quote]

Tue, 05/22/2007 - 07:13

#28

rayedillon

a littlle over 4 years ago

a littlle over 4 years ago we were in this same situation. the differance is we did our own study. we used a "community flush bag" with an antireflux valve and the bag was spiked and changed every 24 hours by the pharmacy. for 6 weeks we cultured EVERY bag from 2 locations and were unable to grow anything. (we even layed a couple bags on the floor before we cultured and still couldnt grow anything. the valve we were using was made by bbraun and had an "umbrella" over the spike and our practice was to always have a syringe attached. when you took the syringe off you automatically replaced with another clean syringe. this WAS evidence based practice and the nurses loved the convenience and flexibility not to mention the cost effectiveness. unfortunately when the ISMP recommended eliminationg multidose flushes our bags were eliminated. the contaminations that occurred were NOT as a result of multidose bags with anti reflux valves. I think the valves are reliable (they use them in the pharmacy to reconstitute meds) and i wish we were still using them.

Fri, 07/27/2007 - 00:34

(Reply to #28) #29

Jan Wesselink

In FL we used to use the

In FL we used to use the community bag. We also did a study culturing the bags and didn't grow anything. The policy was to use the umbrella spike, and to always replace the syringe used with a sterile one, so that it was always "capped". The problem I had with them was the frequency I found them "uncapped" on the units. I usually kept 'my' bag on my cart and only used the bag I spiked and monitored myself. The hospital has since switched to the single use flush syringes.

Thu, 06/03/2010 - 20:38

#30

Chris Cavanaugh

CDC issues One and Only Campaign Brochure, Posters and video

The One and Only campaign for safe injection practice clearly states that "community" flush bags are not good infection control practice. You can get posters to put up and brochures to share with colleagues at www.oneandonlycampaign.org

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

Fri, 06/04/2010 - 04:58

(Reply to #30) #31

swiftymartin

Thanks for the tip on the website

anything we can do to cut down on CRBSI

Fri, 06/04/2010 - 15:45

(Reply to #31) #32

lynncrni

This dangerous practice of

This dangerous practice of using large volume bags or multiple dose vials for catheter flushing solution must be stopped. I was at a CDC meeting a few days ago about this very issue. Since 1999, 125,000 people have been notificed of potential exposure to HBV, HCV, and HIV due to these bad practices, primarily in nonacute settings. Single dose flushing systems is the national standard of care. 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

Fri, 06/04/2010 - 17:29

#33

ann zonderman

I am just astonished that

I am just astonished that this is even considered. Besides the so obvious: potential for contamination, single use issues and the fact that IV solution bags should not hang more than 24 hours. Just what are they thinking... if it is a $ issue - consider cost analysis of one infection, one law suit.

Ann Zonderman, BSN, JD, CRNI

Tue, 06/08/2010 - 03:24

#34

mary ann ferrannini

I was a little stunned when

I was a little stunned when I read this!!!! We have been using pre-fills since they first became available b/c of the nice but pushy IV team....and I mean that in a good way!!!!

Wed, 06/09/2010 - 15:03

#35

Gwen Irwin

Community flush bags

There is a "One and Only Campaign" initiated by the CDC and Safe Injection Practices Coalition. Here is a link to a 10 minute video that they use and discuss community bags (and more) as unsafe.

http://blogs.hcpro.com/osha/2010/06/one-and-only-campaign-releases-safe-injection-practices-video/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+OshaHealthcareAdvisor+%28OSHA+Healthcare+Advisor%29

Gwen Irwin

Austin, Texas

Wed, 06/09/2010 - 15:08

(Reply to #35) #36

lynncrni

The direct route to this site

The direct route to this site is http://www.oneandonlycampaign.org/default.aspx. This is a new inititative from CDC due to the fact that 125,000 people have been tested for exposure to bloodborne pathogens over the past 10 years. This exposure has primarily come from bad practices in non-acute settings such as doctors offices. A few weeks ago, I attended a meeting at CDC about this issue. It requires lots of education so please pass the word on this site. 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

Wed, 06/09/2010 - 15:15

(Reply to #36) #37

lynncrni

Here is another story that

Here is another story that just came across my emails. It does reference what we were discussing at this CDC meeting and the lax infection control procedures in non-acute settings. I heard an audiologist tell her story of being infected with hepatitis while receiving chemotherapy for breast cancer in the outbreak reported in Nebraska a few years ago. This outbreak was caused by the use of a community flush bag for all patients. Her and her family practice husband have their own website - http://www.honoreform.org/

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

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