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Re: Blood collection

#68630
Fiona de Sousa
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Author:
Fiona de Sousa

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Hi Teresa,

We use 70% alcohol as skin prep. In relation to the 5 moments with
pathology collectors we found poor compliance with our initial auditing
but it has improved with repeated audits.

We spent time with the collectors discussing the 5 moments and pulling
apart a blood collect to determine the critical points of it. The
manager of the area is also very supportive which has assisted in
change.

We have defined the start point of the procedure as the application of
the tourniquet. Throughout the procedure staff can access items from
the top of their trolley e.g. skin prep / blood tubes etc. However if
they open the drawer of the trolley to get something this is considered
a break in the procedure and hand hygiene is expected.

Once staff understood this their compliance rates improved as did their
preparedness pre procedure.

Kind Regards,

Fiona De Sousa
Infection Prevention & Control Coordinator, SAH

—–Original Message—–
Behalf Of Matthias.Maiwald@KKH.COM.SG

Dear Teresa, dear Group,

Here is a recent meta-analysis on this topic:

http://www.ncbi.nlm.nih.gov/pubmed/21194791

It becomes clear that the best results were obtained with alcohol-based
products. Alcoholic iodine tincture performed well, as did a combination
of
alcohol plus chlorhexidine, as you describe. The authors also state that
alcohol alone (e.g. 70% isopropanol) was not inferior to any of the
combination products where alcohol is combined with other ingredients.
The
authors also conclude that alcohol on its own may be OK to use, but
there
not enough data points comparing alcohol alone versus alcohol plus
chlorehexidine.

The authors also conclude, as we have also stated in an earlier letter
to
the editor () that skin antisepsis prior to blood culture collection
requires powerful immediate microbial kill, but no sustained action (as
opposed to central venous catheters and surgical sites). When looking at
the chlorhexidine component in the combination of alcohol plus
chlorhexidine, that, however, is the main contribution from
chlorhexidine,
not the immediate kill.

Further important for blood culture collection, although not well
documented in publications, is repeated application of the antiseptic
(e.g.
2 x) and an overall contact time of 1-2 minutes, which is distinctly
longer
than for ordinary venipuncture.

Best regards, Matthias.


Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

Teresa Lewis

To
Sent by: AICA AICALIST@AICALIST.ORG.AU

Infexion
cc
Connexion

Blood collection

19/05/2011 09:25

AM

Please respond to

AICA Infexion

Connexion

Hello everyone

I would like to know what the practice is in other facilities for skin
preparation prior to blood collection, especially prior to collection of
blood for blood cultures?

I believe best practice is to prep skin with 70%alcohol + 2%
chlorhexidine,
am I correct in this?

Yet I find that the practice of most blood collectors is to use just 70%
alcohol. And I note that as much education I give to them re-the 5
Moments,
their habits are very difficult to change.
They are performing a procedure which involves great risk of
contamination
to the patient yet, it appears that all staff do their own thing
re-technique and sequence of doing things and glove use.

It also seems that as soon as I have trained someone in the correct
technique in regards to hand hygiene they are then moved to another
location and I need to start all over again. Some of the staff feel
that
they have been doing the same job for 20 years and don’t feel there is
need
to change anything.
Has anyone had any success in involving the pathology/ blood collecting
staff in the ownership of prevention of infection? If you have, could
you
please share how you have done it.

Thanks, hope you all have a great day.
PS. (Sorry if this is a dumb query)
Teresa

Teresa Lewis
Infection Control/Prevention
Clinical Nurse Consultant
Newcastle Private Hospital
Email:teresa.lewis@healthscope.com.au

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