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aushia68
Disinfect

My foster son has a duel lumen central line that is used for TPN and other meds. I was first told, to use alcohol wipes, to clean the caps with.  In one of our trips to the hospital, I was told that only betadine should be used to clean the caps. We were just at U of M Hospital a couple days ago,  and I was told that betadine is good for the skin with dressing changes, but alcohol works better to clean trhe caps. Which is right?

lynncrni
According to the latest

According to the latest information from the CDC, alcohol, povidone iodine, and chlorhexidine gluconate can be used as the disinfectant agent for the connection surface of needleless connectors. My personal preference would be to place povidone iodine at the bottom of the list because it can leave a tackly residue. This will allow the attached tubing to adhere to it making it difficult to disconnect when the infusion is complete. Alcohol pads will work just fine. The most important factors are to

1) scrub the connection surface and the luer lock threads of the needleless connector for at least 15 seconds with lots of friction.

2) scrub before each connection. In other words, if you are flushing with saline, then giving the infusion, then more saline flush, then heparin, this is 4 connections and 4 alcohol pads and 4 scrubs

3) let it dry before you connect the syringe or set

There is a new group of products called protective caps that is intended to prevent contamination and protect the needleless connector between uses. Many hospitals are now beginning to use these. They are plastic caps containing an alcohol soaked sponge. They luer lock over the needleless connector and remain in place between infusions. We really do not have a good understanding of what is actually on these needleless connectors - individual organisms, biofilm, drug precipitate, dried blood, skin oils, lint, or other environmental contaminates. So protection between uses sounds like a good idea to me.

Also, make sure you are changing the infusion sets every 24 hours. If they are disconnected for reuse within that 24 hours, the male luer end must be covered with a new sterile end cap after each use. Then they must be discarded at 24 hours.

Hope this helps Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

sstrong
response t disinfection

If the line is never put down or touched to anything after the first scrub, then once completed a new alcohol is scrubbed to remove any residual blood, etc, must it still be cleaned  4 times?

Sallie

blodahl
SASH Technique requiring 4 scrubs

We all know there are nurses who do not scrub once during a SAS or SASH technique let alone trying to get them to increase their practice to 3 or 4 15-second scrubs. Lynn, is there a study that compares one 15-second scrub then completing the SAS or SASH process (without letting go of the hub; only touching the female hub with sterile male syringe/tubing tips) with that of 3 or 4 15-second scrubs to complete the SAS/SASH process?

What are consequennces/reprimand to nurses who are non-compliant with this practice? 

Barbara

lynncrni
Please provide the reference

Please provide the reference information for the study you mentioned. This may be appropriate if you are always pushing drugs from syringes. However, if you are infusing any drugs, and therefore having the NC and set lay in the bed for 30-60 minutes, it must be cleaned again before you flush with saline and heparin at the end of the procedure. Thanks, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

blodahl
Lynn~ I was responding to

Lynn~ I was responding to your entry where you said "SASH requires 4 connections and therefore 4 alcohol pads and 4 15-second scrubs" - I thought you were applying this to any interaction with a capped line (i.e., medication administration via syringe bolus, lab draw, intermittent infusion, etc.). I have no question about it requiring additional scrubs when there's an infusion involved and time lapse, or when you're having to clean blood off connection during lab draw, but in the event of a medication bolus by syringe when you don't let go of the connection, I think it's a hard sell to nurses to scrub 15-seconds between each connection when all connecting tips are straight from the package and sterile and you've not let go of your cleansed hub or needle-free connector. Thus, I was asking you if you are aware of a study showing the necessity for 4 alcohol pads and 4 15-second scrubs during SASH procedure when you've not let go of the hub??? I'm sorry if I didn't make this clear.

Barbara

lynncrni
The practice recommendations

The practice recommendations have always been, based on my experience, to clean with each connection. This is based on expert opinion, a form of evidence albeit a low level of evidence. So there is no study that I can referred you to. Sorry, I thought you were saying you knew of such a study. This along with many other aspects of care are not addressed by research yet. Based on the concept that more cleaning is always better than less, I do not think it is unreasonable to expect 4 cleanings for 4 connections. Marcia Ryder is now saying that the bugs reside on needleless connectors in the form of biofilm, which is strongly adhered to the plastic and difficult to remove. If this is true, them 4 times with friction may not even be sufficient to remove it. Also, I think it is difficult for some nurses to actually hold the catheter hub and syringe, scrub, remove the syringe tip cap, etc without laying the hub down. Scrubbing may not reach all surfaces of some NCs, especially those with gaps between the outer wall and center post. So the first syringe connection could bring more bugs to the connection surface, which would only be forced back in with the 2nd syringe. So more scrubbing will always be better until we have more data. Lynn

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Interventional ...
disinfect

Chlorascrub, which is chlorhexadine and alcohol has a small single use pad now for this application. We supply it to our nursing staff and find it more effective than just alcohol but you still need to wipe the port/s for 15 seconds and allow to dry.

AMParry
Disinfect

We teach every access every time as per Lynn's comment

Using the SASH method you access 4 times so it is FOUR alcohol wipes (or whatever your facility uses)

 We don't teach povidone iodine as it is tacky after it dries and it can be difficult to disconnect the line from the needleless connector.  I know it is in the list from the CDC but I have always been taught that povidone iodine is not very effective on objects, it is much more effective on skin.

 

Ann Marie

 

Ann Marie Parry RN CRNI

VITALine Infusion Pharmacy

[email protected]

Ann Marie Parry, RN, CRNI, VA-BC

[email protected]

lynncrni
I have also seen times when

I have also seen times when povidone iodine causes the sets to adhere together making it very difficult, if not impossible, to separate them. I also think that povidone iodine does not make a great disinfectant of inanimate objects, although the new CDC guidelines are supposed to have this listed as an agent to clean needleless connectors. I still would not use it. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

dan.izzo
disefectant

There is a device called the Swab Cap that can be placed on the needle free valve between infusions that is 70% alcohol.  Once removed the valve is disinfected and ready to use.  Just place a new Swab Cap on after disconnection.  Visit this website for more information or contact me.  http://www.excelsiormedical.com/swabcap.php

 Sincerely,

 

Daniel G. Izzo, RN

Regional Manager

Integrated Medical Systems, Inc.

VMX:       800-468-1518 x13

Mobile:    708-267-0065

 

Small Enough To Care, Big Enough To Deliver

 

 

 

My concern with the swab cap

My concern with the swab cap is how do you effectively monitor when they are placed, replaced, and   taken off and placed  back on again.  We have enough issues with them not using the proper number of alcohol swabs.  I can just see the caps being taken off and put back on again, or left on for an extended periord of time.

dsnyrn

lynncrni
You have a valid concern, but

You have a valid concern, but how do you now monitor compliance with using a new alcohol pad for each enter and properly scrubbing for the suggested 15 seconds each and every time. With one of the protective caps, you will be able to tell that these caps are actually on the needleless connector. You will also be able to monitor the supply and rate of their use in each room or unit and compare that to the number of intermittent meds being given on that unit. We do not know yet which of the following situatoins creates the least risk for the patient:

1. replacement of a used protective cap versus

2. failure to scrub an uncovered needleless connector before each use

When thinking about the failure modes, these are the 2 scenarios that quickly come to mind. You would need to determine the level of compliance now with proper cleaning and your hospital's ability and willingness to stock these caps in convenient areas where they can not be overlooked or forgotten. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Lynn,  You are such a great

Lynn,  You are such a great source of information.  I greatly appreciate your comments.  During our hospital orientation class, the charge RN from the IV team has started teaching a class and is  stressing all the points described.  She also asks them to always keep in their pocket the sterile caps and alcohol swabs.  Any tips on how to collect data and better track compliance would be appreciated.

Ty Andrea

dsnyrn

lynncrni
Observation would be the best

Observation would be the best method. You can do point prevalence studies where you set aside a certain period of time on a given day and have all patients on each unit assessed for the condition of their NC and hanging sets. This would be like a snapshot of what is happening at that time. if done over a few months, it would give you an idea of certain trends. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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