Forum topic

 The CHG products currently available in the US are only labeled as skin antiseptic agents, indicating application to skin. To my knowledge no product has changed their labeling to include disinfection of objects such as plastic catheter hubs. We do not have any information about how the CHG will work on any inanimate object. While the killing effect on microorganisms may still be the same or virtually the same, there could be other unintended consequences such as what you mentioned. CHG binds to skin cells to become more effective with each use. Does the same thing happen with plastic? How does this cummulative effect alter the plastic? All CHG products have alcohol which is the faster actiing agent. Does this mean that the alcohol in the CHG products is what is truly doing the job and the CHG is not needed? If so, we are paying for the CHG when a cheaper alcohol swab would work. These are just some of the unanswered questions. We are all still waiting for these answers and in the meantime, it seems that alcohol when used correctly will work just as well. By correctly, I mean one alcohol pad used before each entry into the system. SASH would require 4 alcohol pads and 4 times to thoroughtly scrub that connection. This does not mean 1 pad used 4 times or with only a 2-3 second swipe. Use of the disinfection protection caps is producing good outcomes. Posters have been presented and a publication is in the works. Those only use alcohol. I am only aware of one very small study using a sequential cohort design. They measured CRBSI with alcohol pads to clean connections for the first period, then switched to CHG for the second period. They did document fewer CRBSIs in the second period, however there were lots of confounding variables. There was no training before the data collection on the alcohol period but there was training before the CHG period. Also during the CHG period there was audits of hand hygiene going on, which could have also been responsible for the decreased rates of CRBSI. Read this study and make your own decision. it is the only one I know of. 

1. Soothill, J.S., et al., A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: A pediatric single center before/after study on a hemopoietic stem cell transplant ward. Am J Infect Control, 2009.

Lynn

I would agree with Lynn; however, the CDC's: BSI Guidelines for 2011 page 20 under the Heading: Needleless Intravascular Catheter Systems Line #4 states, "Minimize contamination risk by scrubbing the access port with an appropriate antiseptic (chlorhexidine, providone iodine, an iodophor, or 70% alcohol) and accessing the port with only sterile devices (189, 192, 194-196). Category 1A. Therefore, some teams within our acute care have decided this to mean cleaning of the inanimate objects such as the needleless cap with CHG swabs. I would also agree that it leaves a sticky residue, especially w/ PN.

 It does seem strange that one governmental organization (CDC) does not pay attention to what the other agency (FDA) has done or is doing. Lynn

This topic has just come up at work. The PDI Prevantics website now states they are FDA approved for a 5-second scrub and 5-second dry. Website is http://pdihc.com/all-products/prevantics-device-swab . The website also states this is according to INS Standards of Care though no year is stated. I saw the CDC website that supports CHG on the hubs.

Questions:
1. Is there other literature or research support of CHG on the inanimate hubs vs. alcohol alone?
2. Are the new Standards going to be supporting CHG over alcohol scrubs?
3. Does anyone know approximately when the new Standards are coming out?

Thank you,
Carole

The study that Kaler, et al  in 2007  (Successful disinfecton of needleless access ports: a matter of time and friction) did showthe same outcomes using CHG wipes vs Alcohol wipes.  CHG did not preform better.  PDI has just recently come out with a CHG wipe that is specific for devices, however, users have reported a stickyness on plastics after using.  There is also the added expense.  

It is actually less expensive to use an antiseptic needleless connector and simple alcohol wipes then it is to purchase CHG wipes or alcohol caps.  And, it is more effective on reducing the risk of infections in the long run.  The connector is 100% compliance, it works by simply putting it on, you can't get 100% compliance with swabbing or caps. 

Is it acceptable to have 80% of your staff following 80% of your policies 80% of the time?  The calculation works out to only 51% compliance! Something to think about...