Our facility is beginning the process to implement the addition of an alcohol impregnated cap for all central lines, PIV's, IV tubing, etc... there has been significant talk regarding the "scrub the hub" prior to accessing the cap after removal of the AIC. Also, there is conflict about scrubbing the hub after use before applying the AIC. Our Infection Control department feels that scrubing the surface to remove any visible or non-visible soil before placing the AIC on or scrubbing the hub upon removal of the AIC before accessing (especially if unsure of the length of time that the AIC has been on) is good practice and should reflect so in the policy. We want to provide safe care for our patients and at the same time, avoid mixed messages and confusion among staff regarding best practice. Could you share your insights or thoughts, or any EBP material that you might know of that I could refer to? Thanks so much.
Check the instructions for the brand in use. Most are effective within 3 to 5 minutes after applied. So if it has been on since the last dose hours before, there is no need to scrub again. You do need to clean the connection surface with each ENTRY into the lumen. Giving intermittent meds requires 3 or 4 entries, depending upon whether you are using heparin or not. You will need a new alcohol pad to clean the connection surface between each of these connections. There are no studies to look at how long this cleaning should be. One you have connected the first saline filled syringe, flushed, and aspirated, there could be blood tinged fluid left on the surface. So a new alcohol pad to clean. Then connect the short infusion and it is in the patients bed for 3- to 60 minutes so disconnect and clean again with a new alcohol pad when the med is infused. Attach the saline syringe and flush. Then clean again with another new alcohol pad before the heparin syringe if used. Again, no studies have been done to establish the length of these manual cleanings but you are starting with a connection surface that is much much cleaner than one without any protection between med doses. 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