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In the Menyhay prospective in vitro study, 20 (67%) of 30 NC disinfected with 70% alcohol resulted in transmission of contaminants (442�C25,000?CFU) yet 60 tested with barrier caps (containing 2% chlorhexidine and 70% alcohol) showed only one (1.6%) with transmission of contaminants [19]. In both the Kaler laboratory and the Ruschman randomized experimental design studies, using a 15 second and GDC-0449 chemical structure 60 second scrub respectively, disinfection with 70% alcohol eliminated all microorganisms [173, 181]. Kaler performed laboratory testing on contaminated NC with a small sample using 70% alcohol and alcoholic chlorhexidine and found both to be effective for hub disinfection [181]. Two additional studies gave conflicting results. Rupp demonstrated 5 second alcohol disinfection was effective; this was in direct contrast with the Smith study where contact time of 10/12/15 seconds was deemed adequate, but 5 and 8 seconds Quinapyramine were not as effective to prevent bacterial transfer [170, 171]. Simmons and colleagues found 3/10/15 seconds significantly decreased the bacterial load in an in vitro laboratory study, with some level of bacteria remaining during all duration levels tested; disinfection failed to completely eliminate contaminants [13]. More studies are needed to provide efficacy for optimal time necessary to eliminate surface contaminants. Research of Macias and associates with 2% chlorhexidine in 70% isopropyl alcohol on skin proved an added substantive effect, even against freshly introduced organisms, for up to 24 hours, establishing this agent as a superior disinfecting agent when longer action is needed, in comparison with single agents of 70% isopropyl alcohol, 10% povidone iodine and 10% sodium Selleckchem MS 275 hypochlorite [172]. Alcoholic chlorhexidine performed consistently well or better than other disinfection agents in multiple studies [21, 24, 131, 168, 172, 179, 182]. In the research by Hong et al., a 5 second scrub with alcoholic chlorhexidine fully disinfected NC surfaces treated with Pseudomonas Aeruginosa [179]. In the most recent Epic3 United Kingdom report of evidence-based guidelines, recommendations by expert consensus include a 15 second cleansing with alcoholic chlorhexidine prior to and after each access [53]. In actual practice disinfection prior to access is expected, while cleansing after each access is rarely done. 3.4.