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Nurses are very familiar with the use of Chlorhexidine; however are you aware of the recent recommendations to reduce risk to our patients? ‘Critical incidents in Australia have been reported where chlorhexidine antiseptic solution was drawn up into a syringe and administered via the epidural route, resulting in serious patient harm. Contributing to this risk are the practices of placing chlorhexidine in an open container on the sterile field in preparation for skin decontamination, drawing up from open containers rather than from ampoules, and not labelling syringes at the time of medicine preparation.’
The Australian Commission on quality and Healthcare has released a statement on chlorhexidine that all Nurses should read.
‘Wrong-route administration errors by the intrathecal or epidural route are a small, but highly significant, proportion of medication injection errors. Incident reporting from states and territories indicates that patient harm from wrong-route injections into the intrathecal or epidural space is infrequent, but continues to occur.
‘To reduce the risk of accidental injection of chlorhexidine, when used as a skin antiseptic, and improve patient safety, the Australian and New Zealand College of Anaesthetists (ANZCA) and the Australian Commission on Safety and Quality in Health Care jointly recommend that:
- Non-injectable fluids, including chlorhexidine, never be decanted into an open container in a sterile procedure area
- Skin preparation is completed before establishing the sterile procedure area
- Unless contraindicated, swabs impregnated with chlorhexidine are used when chlorhexidine is required for skin preparation before administering epidural, intrathecal or other perineural injections, and before inserting central venous lines
- If chlorhexidine liquid is used, it is dark-tinted to provide a visual cue that the liquid is noninjectable
Non-injectable fluids remain outside the sterile area
- Injectable medicines are not decanted into a gallipot or other open container before preparation and injection; if this is unavoidable, any medicine that is decanted should be immediately drawn up and labelled
When more than one solution is present in the sterile area, each is labelled in accordance with the National Standard for User-Applied Labelling of Injectable Medicines, Fluids and Lines
- Other strategies to reduce the risk of accidental chlorhexidine injection include:
Using pre-labelled, pre-filled syringes
Ensuring that chlorhexidine-impregnated swabs are the only form of chlorhexidine available in the procedure area.
You can download the statement on Topical application of chlorhexidine and the risks of accidental injection here>>
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