Course Access
I had a conversation off-line with Tim Spencer about this, and he agreed we could post it as I think it is pertinent to this discussion.
Cheers
Michael
Agreed. I went back and re-read the opening paragraphs on it and its definitely what you say.. no question about it.
It’s funny that CDC specifically mention the use of non-antimicrobial soap in other respective guidelines but not specifically in their intravascular guidelines.
Which is all the more reason why I prefer other guidelines over the current CDC version – I tend to think the 2011 version is a poor follow-on from the earlier 2002 edition, hence why I use INS and SHEA guidelines more frequently these days.
Hope all is well in sunny Brissy..
Tim..
Hi Tim
I don’t disagree, it’s just that when I looked at the attached HICPAC 2011 guidelines it had plain soap! Weird.
Thanks
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
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Hi Michael,
Which guideline are you quoting from? Is it a BSI specific guideline?
Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update
Jonas Marschall, MD; Leonard A. Mermel, DO, ScM; Mohamad Fakih, MD, MPH; Lynn Hadaway, MEd, RN, BC, CRNI; Alexander Kallen, MD, MPH; Naomi P. O’Grady, MD; Ann Marie Pettis, RN, BSN, CIC; Mark E. Rupp, MD; Thomas Sandora, MD, MPH; Lisa L. Maragakis, MD, MPH; Deborah S. Yokoe, MD, MPH Infection Control and Hospital Epidemiology, Vol. 35, No. 7 (July 2014), pp. 753-771
This current SHEA/HICPAC updated guideline from July 2014 states;
B: At Insertion
2. Perform hand hygiene prior to catheter insertion or manipulation (quality of evidence: II).83-87
a. Use an alcohol-based waterless product or antiseptic soap and water.
i. Use of gloves does not obviate hand hygiene.
The earlier publication from SHEA/HICPAC from 2002 also state;
III. Hand hygiene
A. Observe proper hand hygiene procedures by washing hands with either conventional antiseptic-containing soap and water or waterless alcohol-based gels or foams. Observe hand hygiene before and after palpating catheter insertion sites, as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be done after the application of antiseptic, unless aseptic technique is maintained.2,23-28 Category IA
B. Use of gloves does not obviate the need for hand hygiene.2,26,27 Category IA
Boyce JM, Pittet D; Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America. Guideline for hand hygiene
in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
MMWR Recomm Rep 2002;51(RR-16):1-45.
This paper also states the differences in terminology when it comes to hand hygiene.
Hand antisepsis. Refers to either antiseptic handwash or antiseptic hand rub.
Hand hygiene. A general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.
Handwashing. Washing hands with plain (i.e., non-antimicrobial) soap and water.
I think the key points are also the combinations of the ‘bundles of care’ prior to any IV device insertion (checklist, appropriate hand hygiene, maximal barrier precautions, use of CHG as skin antiseptic, optimal insertion site and surveillance practices).
As long as hand hygiene compliance is being monitored, then we are working towards lowering infections and device related complications.
As a vascular access specialist, I take into consideration the specific vascular access related guidelines as well as those from the infection control realm. 🙂
Tim..
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Director-at-Large, Vascular Access Certification Corporation (VACC)
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com
“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” – Steve Jobs
Hi Tim
Interestingly, the US HICPAC BSI guidelines has this:
Hand Hygiene and Aseptic Technique
1. Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained [12, 77-79]. Category IB
This recommendation seems to be generic for all intravascular devices from what I can see. No specific recommendation for hand cleaning with an antiseptic solution prior to CVC insertion.
Cheers
Michael
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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