Infusion Nurses Society (INS) 2021 Guidelines Update: Q&A with Infection Prevention Expert on Guidance for Skin Antisepsis

Author: Holly Montejano, MS, CIC, CPHQ, VA-BC

Categories: General Infection Prevention & Skin / Device Antisepsis June 17, 2021
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In January 2021, the Infusion Nurses Society (INS) released the 8th edition of the Infusion Therapy Standards of Practice, which is revised every 5 years. With this revision came a practice recommendation pertaining to skin antisepsis which caused some concern regarding acceptable product (or product requirements) for skin preparation prior to vascular access device (VAD) placement and for care, and maintenance, of the insertion site during dressing changes. In May 2021, INS updated the Infusion Therapy Standards with four (4) corrections that supersede the January recommendations. This Q&A is intended to address some of the questions as a result of this update.

Q; Who refers to the INS standards of practice and why is it important?

A:Infusion practice is comprised of healthcare professionals with varying job titles across a range of practice settings all with the common goal of providing evidence-based healthcare in a safe and effective manner. The practice recommendations are intended to ensure competent practice and maintain patient trust while delivering patient-centered infusion care.

Q: What did the 2016 Standards of Practice Document recommend for skin antisepsis prior to vascular access device (VAD) placement, as well as for care and maintenance of the insertion site?

A: The 2016 practice recommendations were a bit different than the 2021 document; the skin antisepsis recommendations in 2016 were provided separately for insertion and care and maintenance:

For insertion, the skin antisepsis recommendations were as follows:

Cleanse insertion site with antiseptic solution; allow to dry completely.

    1. Chlorhexidine solution (preferred): apply using a back and-forth motion for at least 30 seconds.
    2. Povidone-iodine: apply using applicator and allow to remain on the skin for 1.5 to 2 minutes or longer to completely dry for adequate antisepsis. The use of concentric circles or a back-and-forth-motion for this skin preparation has not been studied.

For care and maintenance of the insertions site, the skin antisepsis recommendations were as follows:

Ongoing assessment, site care, and dressing change: The preferred skin antiseptic agent is >0.5% chlorhexidine in alcohol solution; for any contraindications to alcoholic chlorhexidine solution, alternative antiseptic solutions include tincture of iodine, an iodophor (povidone-iodine), or
70% alcohol.

Q: How did the January released 2021 Standards of Practice document change from the 2016 recommendation for skin antisepsis?

A: The recommendation for product chemistry did not change; an alcoholic-chlorhexidine gluconate (CHG) skin antiseptic is still the preferred chemistry unless clinically contra-indicated:
Perform skin antisepsis using the preferred skin antiseptic agent of alcohol-based chlorhexidine solution. (Level of evidence I)

  • If there is a contraindication to chlorhexidine solution, an iodophor (e.g., povidone-iodine) or 70% alcohol may also be used. (Level of evidence IV)

However, there was an additional practice recommendation regarding the sterility of the product:

Use a single-use sterile applicator containing sterile solution, not a multiple use product (eg, bottle of antiseptic solution). (Level of evidence IV)

  • Follow manufacturers’ directions for use to determine appropriate product application and dry times always allow product to naturally dry without wiping, fanning, or blowing on skin.

Q: What does the INS Standards correction mean for skin antisepsis selection?

A: In May 2021, INS acknowledged four corrections that will supersede recommendations published in January 2021. One such correction includes an update to Standard 33, Vascular Access Site and Skin Antisepsis Practice Recommendation D [Page S96 of the Standards of Practice] which removes the word sterile from the INS 2021 practice recommendation. The use of only a sterile solution for skin antisepsis is not supported by current clinical evidence substantiating the change in guidance.

The new wording is as follows: Use a single-use applicator containing antiseptic solution, not a multiple use product (e.g., bottle of antiseptic solution). (Level of evidence IV)

Q. Can I continue to safely and effectively use the Prevantics® skin products prior to VAD insertion, care and maintenance?

A: PDI’s Prevantics® skin swabs and swabsticks are an ideal product for VAD placement and care and maintenance. The Prevantics Swabstick has a 7-day continued antimicrobial activity on the skin (aligning nicely with central line dressing change schedules) and is a pre-saturated swabstick which does not require cracking of a glass ampule. The dual-sided nature of the swabstick’s applicator tip, in addition to a low profile with squared edges, makes it easy to navigate around an insertion site during VAD maintenance without fear of dislodging the catheter. The soft applicator tip is also gentle on the skin.

The Prevantics Swab (1.0 ml) has a dry site prep time of 15 sec, with a 30 sec dry time- which is shorter than other alcoholic-chlorhexidine products on the market- making overall prep time that much quicker and more likely to garner compliance.

 

INS encourages users to carefully read through the changes and to make the appropriate updates to clinical practice. Please note: a formal correction will be printed in the Journal of Infusion Nursing July/August issue with corresponding links to the digital edition. Click Here to view and download the Standards correction through the INS site.

Author

Holly Montejano MS, CIC, CPHQ, VA-BC
holly Clinical Science Liaison, PDI Gulf Coast

Profile

Holly’s passion for infectious disease epidemiology developed during her undergraduate studies at University of Connecticut, where she studied biology and anthropology – and the profound impact of disease on people, public health and within healthcare systems. This passion led to a graduate program focused in infectious disease epidemiology and a post-graduate epidemic intelligence service (EIS) fellowship in public health, and a graduate certification in infection control at the University of South Florida.

After several years as a public health epidemiologist, Holly transitioned into infection prevention and healthcare epidemiology where she currently is part of a dynamic clinical affairs team, supporting the Gulf Coast region as a Clinical Science Liaison (CSL).

Contact

Phone: 321.439.7923

Company Website: Pdihc.com

Email: Holly.Montejano@pdihc.com

Hobbies

Interior design
Beach staycations
Little League baseball and softball

Education

University of Connecticut, Storrs, CT
Bachelor of Science in Biology and Anthropology

Colorado State University, Fort Collins, CO
Master of Science in Environmental and Radiological Health Sciences (Epidemiology and Infectious Disease)

Certification
Certification Board of Infection Control (CBIC)- CIC
Certified Professional in Healthcare Quality (NAHQ)- CPHQ
Vascular Access- Board Certified (VA-BC)
Lean Six Sigma Yellow Belt Certification
Prosci Change Management Certification

Why I love what I do

Infectious disease epidemiology – from both a biological and anthropological standpoint – have always been a passion of mine. Studying the effects of disease on populations (from a public health standpoint and from that of an Infection Preventionist) has fueled my interest in patient safety and quality outcomes initiatives. My work of providing clinical expertise and evidence-based guidance on infection prevention products (which are used in communities and healthcare systems daily) bolsters the satisfaction I experience in this role.

Areas of Expertise

Microbiology and infectious disease transmission
Infection Prevention
Patient Safety and healthcare quality
Safety culture
Public Health
Vascular access
Environmental disinfection
Performance Improvement
Education

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