Wonder if there is a new recommendation to use CHG as disinfectant for needleless connector instead of 70% isopropryl alcohol? Does CHG damage the catheter material? And should we use CHG-dressing instead of non-CHG dressing for all CVAD, or just for high risk patient population only?
Disinfect the connection surface and sides of the needleless connector attached to any VAD to reduce introduction of intraluminal microbes. Use active or passive disinfection. Follow manufacturers’ directions for use of both the needleless connector and disinfect- ant agent. Primary factors influencing this practice include the disinfection agent, the time required (ie, application and drying), and the method of application.
1. Perform active disinfection by a vigorous mechanical
scrub using a flat swab pad containing 70% isopropyl alcohol or alcohol-based chlorhexidine suitable for use with medical devices.
a. Recent studies show no difference in effective-
ness of scrub time between 5 to 15 seconds with 70% isopropyl alcohol and alcohol-based chlor- hexidine gluconate, and researchers have sug- gested that removal of all organisms may not be possible when there is extensive contamination.
b. An additional type of active disinfection device contains an alcohol-impregnated sponge used to apply the mechanical scrub prior to use of a needleless connector and the internal lumen of a stopcock and is immediately discarded after the scrub time. In vitro testing has shown this device to be ineffective for decontamination of the internal lumen of a stopcock. For disinfecting needleless connectors, one in vitro study reported this device to be equal to an alcohol pad and another study reported moderate effectiveness, meaning that 5% to 15% of surface contamination was left on 2 types of needleless connectors when compared to use of an alcohol pad. Clinical performance and outcomes with this device have not been reported.
c. Drying time with 70% isopropyl alcohol is 5 sec- onds; alcohol-based chlorhexidine requires 20 seconds. Povidone iodine requires longer than 6 minutes to be thoroughly dry, making it less favorable to clinical practice. Drying times in clinical practice depend on the humidity and cli- mate in the care setting.4,27-33 (II)
2. Perform passive disinfection by applying a cap or covering containing a disinfectant agent (eg, 70% isopropyl alcohol, iodinated alcohol) to create a physical barrier to contamination between uses. Follow manufacturers’ directions for use regarding time for effectiveness after attachment and the
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VOLUME 44 | NUMBER 1S | JANUARY/FEBRUARY 2021
maximum length of effectiveness. Once removed, discard used disinfection caps and do not reattach to the needleless connector. Use multidisciplinary implementation strategies including staff education and leadership support and provide consistent feed- back to staff regarding outcomes, as this has been shown to decrease catheter-associated bloodstream infection (CABSI) rates.28,34-36 (I)
3. Studies comparing active and passive methods of disinfection show both processes to be effective.
a. Active disinfection with alcohol-based chlorhexidine gluconate swab pads or passive disinfection with caps containing 70% isopropyl alcohol were associ- ated with lower rates of CABSI, while swab pads containing 70% isopropyl alcohol were the least effective according to a meta-analysis of quasi-ex- perimental studies. A quasi-experimental study did not show a significant CABSI reduction in a pediatric critical care setting, probably associated with a short duration of catheter dwell in this population.
b. A recent RCT on disinfection of needleless con- nectors on central vascular access devices (CVADs) compared 70% isopropyl alcohol wipes, alcohol-based chlorhexidine gluconate wipes, and caps with 70% isopropyl alcohol. CABSI rates were low in both groups using isopropyl alcohol and zero in the group using alcohol-based chlor- hexidine gluconate.30,37,38 (I)
4. Disinfect the connection surface before each entry. a. Studies focus on disinfection practices before the initial entry into the needleless connector; however, studies do not address the need for disinfection before subsequent entries required to administer an intermittent medication (eg, saline flushing before and after the medication, locking the VAD). Although the need for a full disinfection process before subsequent entries is unknown, removal of organic and inorganic debris (eg, blood-tinged fluid, dried medication, clothing lint, inadvertent touch contamination) with a disinfection pad between each entry may provide additional protection for the intralumi-
nal fluid pathway. (Committee Consensus)
5. Adhere to Standard-Aseptic Non Touch Technique (Standard-ANTT) when accessing and changing a
a. Attach only a sterile syringe tip or sterile male
luer end of the intravenous (IV) administration
set to the needleless connector.
b. Ensure that disinfecting supplies are readily available
at the bedside to facilitate staff compliance with needleless connector disinfection (see Standard 18, Aseptic Non Touch Technique).3,4,7,39 (IV)
6. Use of needleless connectors with an antimicrobial coating (eg, silver, chlorhexidine/silver) requires ade- quate disinfection techniques, as technology alone does not replace disinfection practices.
Scrubbing the needleless connector is not going to allow the disinfectant agent to reach the catheter itself. The catheter hub will be exposed to the solution but that is a different material than the catheter itself. CHG products used for skin antisepsis in the USA contains 70% alcohol and that can cause changes in the plastics used to make the catheter itself. The catheter hub may also be softened by the alcohol. This means you must make certain that the catheter hub is thoroughly dry before you attach a new connector or tubing of any kind. See the INS SOP above that was copied and pasted. You actually need the entire document which requires purchasing from the INS. use of CHG dressing depends on your hospital CLABSI rates. Some use a CHG dressing, some use tissue adhesive, some use both.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thank you both