ChloraPrep One-Step, approved by the FDA as a patient preoperative skin prep, is the only 2% CHG and 70% IPA-based antiseptic available in the United States which meet the new guidelines.
Antimicrobial Solution
70% Isopropyl Alcohol
• Requires a one minute scrub
• Must be allowed to air dry
• Rapidity of Action: Immediate (denatures proteins)
• Persistent Activity: None
Tincture of Iodine
• Combination product of Iodine and Alcohol
• One step application
• Dries quickly
• Should not be used if allergic to iodine
• Rapidity of Action: Immediate (free iodine penetrates cell and replaces components)
• Persistent Activity: None
Iodophors*
Iodine with a fixed carrier molecule.
• Must allow to air dry (2-3 minutes)
• Masks visualization of the vein
• Effects are neutralized by organic material (blood, etc.)
• Rapidity of Action: When dry
• Persistent Activity: 2-3 hours (in vitro)
Chlorhexidine*
• Broad-spectrum
• Affinity for binding to the skin
• Superior efficacy-
• CDC, INS, Maki recognize Chlorhexidine as "best practice"
• Less skin irritation
• Bactericidal activity in the presence of blood
• Rapidity of Action: 30 seconds
• Persistent Activity: up to 48 hours
*Incidents of bacterial contamination have been reported in aqueous antiseptic solutions. It is recommended that only sterile aqueous solutions be used for skin preparation.
Antimicrobial Ointments
• Benefits remain controversial
• Clinicals have not been conclusive
• Obscures the IV site
• Increase lubricity of the IV catheter
• Difficult to maintain occlusive transparent film dressing
Preventing Infections
Aseptic technique is an integral part of infection control. Strict adherence to handwashing and other principles of aseptic technique remain the cornerstones of preventing hospital-acquired infections.
Specific recommendations for the insertion of peripheral catheters:
• Wash hands (ideally using an antimicrobial skin cleanser)
• Gloving- Sterile gloves are recommended when placing all types of intravascular devices, including peripheral catheters.
• Sterile tape and tourniquets are recommended. If tourniquets are reused they MUST be disinfected.
Specific recommendations for the insertion of central venous catheters: Including: PICC, dialysis, arterial, midline catheters and guidewire exchanges
• Wash hands (ideally using an antimicrobial skin cleanser)
• Implement maximal barrier precautions:
• Sterile gloves
• Sterile long-sleeved gown
• Mask
• Cap
• Large sterile drape
Utilizing aseptic technique is important during insertion, maintenance and routine manipulation of all intravascular devices.
Maintenance of the Site
• Wash hands
• Put on clean gloves
• Open dressing change kit
• Put on mask
• Set up sterile field
• Remove old dressing
• Observe insertion site for erythema, exudates, and catheter migration
• Remove gloves using aseptic technique
• Pull gloves from cuff toward fingertips so that the glove is inside out and dispose
• Put on sterile gloves using aseptic technique
• Use ChloraPrep according to the directions
• Apply appropriate dressing
• Record date, time, type of catheter and initials on tape or dressing
• Always include date of line insertion
