Myth or reality: does the sense for antisepsis impact on reducing bloodstream infection?

Close your eyes and for a few moments imagine yourself participating in a practical training on good practices in accessing the fully implanted catheter. Have you ever wondered what is the most suitable movement for skin preparation: circular movements, from the center towards the periphery or the basic back and forth technique?

ANVISA (2017) recommendations on skin preparation for insertion of central venous catheter propose:

“Rub the skin with alcohol-based solution: chlorhexidine gluconate> 0.5%, povidone-iodine - 10% alcoholic PVP-I or 70% alcohol 7.33-35. (I) 

• Chlorhexidine application time is 30 seconds while PVPI is 1.5 to 2.0 minutes. It is indicated that the application of chlorhexidine should be carried out using back and forth movements and PVPI with circular movements (inside out). (III) 

• Wait for the antiseptic to dry spontaneously before puncture. (III)

It is imagined that after this reading you are asking yourself: does the type of movement performed during the application of the antiseptic on the skin make any difference about its mechanism of action?

Finally, thanks to scientific literature, it is possible to resolve this doubt. Recently published, the German randomized study “The two techniques most commonly used to apply antiseptic to the skin are the concentric circle and back-and-forth techniques”, Written by Carre Y, Moal B, et. al., shows us that there was no reduction in the rate of bloodstream infection when the two for antisepsis of the skin [movements from the center to the periphery or back and forth technique]. The study's finding is that there was no significant clinical difference in reducing the amount of microorganisms when comparing the two techniques used after the 30 seconds that it takes to dry the antiseptic. This finding has a significant impact on the time required for prior preparation of the skin for insertion of the catheter, as there is still no argument to justify the application for 30 seconds, since a single “passage” in concentric circles was much faster with similar results. 

And in your daily practice, is the routine to perform circular movements for 30 seconds? Comment with us what you think about the findings of this study.


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