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Hand hygiene prior to central line insertion

What type of hand hygiene do you use prior to placing PICCs?

What type of hand hygiene do providers in your facilities use prior to placing central lines?

One of our OR RNs is telling our central line simulation faculty that we all should be doing the full OR up to the elbow scrub with Avaguard prior to PICC and central line insertion (for insertions outside of the OR).

We think it is unecessary, impractical, and not part of the standard bundle practices, but I thought I'd throw it out to you all for feedback.


Wanda Warren RN
Hand hygiene prior to PICC insertion

Considering that it is a sterile procedure, I do at least a 2 minute scrub using a surgical scrub brush to each hand (between fingers and under nails) extending half-way up the forearm. I also use the sterile towel that comes with the gown to dry my hands, one at a time, starting with each finger working my way down my wrist. Then I flip the towel and use the other end to dry the other hand. I wouldn't mind doing an OR scrub if I had an OR sink to do it in.

Providers wash their hands with soap at the sink then dry with paper towels.

Gina Ward
hand hygiene prior to PICC line


I have always done basic hand washing with soap and water or with an alcohol based solution.  I have never done a surgical scrub prior to picc line insertion.  I have never seen any physician do a surgical scrub prior to any insertion of a line other than in the surgical area. Of course we know that isnt the critieria for defining what is right or wrong;  :)  

I am washing my hands prior to contacting the patient , assessing veins and positioning them, then again when done and ready to pull supplies out of my cart and set up, then again prior to putting on sterile gown and the next pair of sterile gloves.  

Your question made me think so I pulled out the Infusion Nursing Standards of Practice S27 refers to handwashing. 

It says use of alcohol-based hand rub products or hand washing with soap and water are appropriate for hand decontamination when hands are not visibly soiled, before direct contact with patient's intact skin, before performing aseptic infusion procedures, after contact with objects or equipment in the patients immediate vicinity, and after removing gloves.

Bar soap should not be used, however, liquid sap and water are adequate for hand hygiene.


It says more but those points are what I think answers your question if a surgical scrub is needed.

Thanks,  Gina Ward R.N., CPAN

Gina Ward R.N., VA-BC

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