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Recognising and Preventing Intravascular Catheter- related Infections.

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Presentation on theme: "Recognising and Preventing Intravascular Catheter- related Infections."— Presentation transcript:

1 Recognising and Preventing Intravascular Catheter- related Infections

2 AIM To reduce the risk of infection caused by micro-organisms prior to commencing and during an I.V. therapy To reduce the risk of infection caused by micro-organisms prior to commencing and during an I.V. therapy All Doctors and Nurses must be aware of how to minimise the risk of infection prior to the insertion of an I.V. cannula and during I.V. therapy All Doctors and Nurses must be aware of how to minimise the risk of infection prior to the insertion of an I.V. cannula and during I.V. therapy

3 Learning Outcomes:- The participants will: Be aware of how infection presents itself Be aware of how infection presents itself Identify how catheter colonisation occurs Identify how catheter colonisation occurs Be able to observe patient for signs of infection & to use the VIP score Be able to observe patient for signs of infection & to use the VIP score Identify potential sources of infection Identify potential sources of infection Understand how to incorporate the Saving Lives – care bundles to prevent infection and promote good practice Understand how to incorporate the Saving Lives – care bundles to prevent infection and promote good practice

4 3 rd National HCAI Prevalence Survey Feb - May 2006 A total of 75,694 patients were surveyed 5743 of these had HCAIs, giving a prevalence of 7.59% (95% confidence) HCAI prevalence: England was 8.19% Wales 6.35%, Northern Ireland 5.43% Republic of Ireland 4.89%. Primary bloodstream (7.0%). Journal of Hospital Infection (2008) 69,

5 Are PVCs a risk for BSI? At any one time 61% of hospital patients were found to have a peripheral intravenous cannula or catheter in place 1 At any one time 61% of hospital patients were found to have a peripheral intravenous cannula or catheter in place 1 1.9% of all hospital acquired infections in the UK are due to Peripheral Venous Catheters 2 1.9% of all hospital acquired infections in the UK are due to Peripheral Venous Catheters 2 Catheters inserted in the emergency department had higher rates of infection despite shorter dwell time compared to those inserted on hospital wards 3 Catheters inserted in the emergency department had higher rates of infection despite shorter dwell time compared to those inserted on hospital wards 3 Blood stream infections remain underestimated and potentially serious complications of peripheral vascular catheterisation 3 Blood stream infections remain underestimated and potentially serious complications of peripheral vascular catheterisation HCAI prevalence survey 2 Emmerson et al, JHI, overview of Second National Prevalence survey of infections in hospitals (1996) 3 Pujol et al, Journal of Hospital Infection (2007) 67, 22-29

6 >250,000 central venous catheters are used in the UK annually >250,000 central venous catheters are used in the UK annually 30,000 are associated with infection 30,000 are associated with infection Cost approx £10 million annually Cost approx £10 million annually Mortality> 25% Mortality> 25% Particular problem in haematology and oncology Particular problem in haematology and oncology Are CVCs a risk for BSI?

7 Organisms 10% of HAB were caused by more than one organism 10% of HAB were caused by more than one organism The most commonly isolated organisms from all types of intravenous cannulae are coagulase - negative staphylococci (35%), with Staphylococcus aureus the second most common (25 % ) 1 The most commonly isolated organisms from all types of intravenous cannulae are coagulase - negative staphylococci (35%), with Staphylococcus aureus the second most common (25 % ) 1 Meticillin resistant Staphylococcus aureus (MRSA) accounted for 40–45% of Staphylococcus aureus infections in a 2006 prevalence survey 2 Meticillin resistant Staphylococcus aureus (MRSA) accounted for 40–45% of Staphylococcus aureus infections in a 2006 prevalence survey 2 1 Managing bloodstream infection associated with intravascular catheters. Drug Therapy Bulletin 2001,39:75–80 2 Smyth ETM. Healthcare acquired infection prevalence survey Presented at 6th international conference of the Hospital Infection Society, Amsterdam 2006, Preliminary data available in Hospital Infection Society: The third prevalence survey of healthcare associated infections in acute hospitals, 2006

8 Associated factors Overall, almost 2 / 3 of bacteraemias of known source were associated with intravascular device or were device-related e.g. Catheter-associated urinary tract infection Catheter-associated urinary tract infection Ventilator associated respiratory tract infection Ventilator associated respiratory tract infection Central IV catheters were the commonest source of hospital acquired bacteraemia Central IV catheters were the commonest source of hospital acquired bacteraemia

9 Nosocomial Infection National Surveillance Service. Surveillance of hospital-acquired bacteraemia in English hospitals Sources of hospital-acquired bacteraemia

10 Blood-stream infection (BSI) Approx. 20% of BSIs are caused by haematogenous spread from another body site Approx. 20% of BSIs are caused by haematogenous spread from another body site e.g. urinary tract, wound infection and respiratory tract (Wilson 1995) The majority of such infections originate from intravenous devices The majority of such infections originate from intravenous devices

11 Sources of Infection Intrinsic Sources of Infection/Contamination Intrinsic Sources of Infection/Contamination (Present prior to use) Extrinsic Sources of Infection/Contamination Extrinsic Sources of Infection/Contamination (Introduced in use) Drip Site Infection Drip Site Infection

12 Identify how infection occurs INTRINSIC SOURCES (Present prior to use) 3 Stages in the life of infusion products during which contamination can occur :~ During Manufacture and Packaging During Manufacture and Packaging Transport and Storage Transport and Storage Usage Usage

13 What errors can occur (1) 1990: Johannesburg Death of 15 babies Contaminated IV feeds 2000: India 2000: India Death of 3 young mothers and 3 newborn babies Contaminated IV fluids 2002: Brazil 2002: Brazil 36 n 36 neonatal deaths in Brazil contaminated intravenous fluids. Endotoxin contaminated IV medication 2004: South Africa 2004: South Africa 6 premature babies died Enterobacter cloacae three containers one infusion set A pharmacist's dirty hands the main reason

14 What errors can occur (2) Evans Medical in Speke (not connected with present trading company) Tue 6 th April % Sterile Dextrose Solution - Lot D th Feb – 2 nd Mar deaths at Devonport Hospital 6 th Mar Investigation begins 12 th Jul Clothier Report issued by Department of Health & Social Security Report of the Committee appointed to inquire into the circumstances, including the production, which led to the use of contaminated infusion fluids in the Devonport section of Plymouth General Hospital. (London: HMSO, 1972 )

15 Prevention of infections INTRINSIC SOURCES Action Visual Inspection ~ a vital part Visual Inspection ~ a vital part Observe for leakage: Observe for leakage: ~ Pinhole leaks in PVC bags ~ Cracks in glass bottles

16 EXTRINSIC SOURCES HOW DO THEY OCCUR?

17 Identify how infection occurs EXTRINSIC SOURCES (Introduced in use) Bacterial migration from patients skin/infected sites/contaminated IV fluid Bacterial migration from patients skin/infected sites/contaminated IV fluid Poor asepsis/staffs hands/disinfectants Poor asepsis/staffs hands/disinfectants IV drug incompatibility/additives IV drug incompatibility/additives Line/filter changes/insertion/manipulation of device Line/filter changes/insertion/manipulation of device Reflux of micro-organisms/retrograde contamination Reflux of micro-organisms/retrograde contamination

18 Peripheral Intravenous Cannula Ongoing Care Observation & Record

19 Sources of Infection/Contamination (Drip Site Infection ) Hands of medical/nursing staff Hands of medical/nursing staff Patients own skin and flora Patients own skin and flora Hub contamination Hub contamination Catheter contamination on insertion Catheter contamination on insertion Other infected sites on patients own body Other infected sites on patients own body Contaminated skin disinfectants/ infusate/cannula/admin set Contaminated skin disinfectants/ infusate/cannula/admin set

20 How infection presents itself Local site infection Local site infection Inflammation of the vein (phlebitis) Inflammation of the vein (phlebitis) Bacteraemia and Septicaemia Bacteraemia and Septicaemia Catheter colonisation Catheter colonisation

21 Patients signs of Infection Deteriorating patient condition Deteriorating patient condition Pyrexia Pyrexia Rigors Rigors Tachycardia Tachycardia Tachypnoea Tachypnoea Cyanosis Cyanosis Hypertension Hypertension Confusion/agitation Confusion/agitation No Clinical symptoms No Clinical symptoms

22 Meditech IV Intervention

23 Document intervention

24 How does catheter colonisation occur? The IV device becomes covered by a film of protein such as albumin, fibrinogen and immunoglobulin mixed with micro-organisms and known collectively as a BIOFILM

25 Biofilm Formation Skin bacteria At insertion polyurethane/silicon catheter Jeske C, et al. Anaesth Analg 97: Livesly M, et al. Eur J Clin Micro Infect Dis 17: Elliott T, et al. Eur J Clin Micro Infect Dis 16: Attachment

26 Biofilm Formation Seconds/Minutes Protein/Platelets/White Blood Cells Jeske C, et al. Anaesth Analg 97: Livesly M, et al. Eur J Clin Micro Infect Dis 17: Elliott T, et al. Eur J Clin Micro Infect Dis 16: Attachment & Adhesion

27 Biofilm Formation 1-2 Hours Fibrin Sheath Jeske C, et al. Anaesth Analg 97: Livesly M, et al. Eur J Clin Micro Infect Dis 17: Elliott T, et al. Eur J Clin Micro Infect Dis 16: Adhesion & Maturation

28 Biofilm Formation 2-3 Days Thrombus Formation Jeske C, et al. Anaesth Analg 97: Livesly M, et al. Eur J Clin Micro Infect Dis 17: Elliott T, et al. Eur J Clin Micro Infect Dis 16: Detachment

29 BIOFILM Biofilm helps bacteria adhere to the catheter and resist anti-microbial agents circulating in the blood Biofilm helps bacteria adhere to the catheter and resist anti-microbial agents circulating in the blood It can be difficult to treat catheter- related infections without removing the device It can be difficult to treat catheter- related infections without removing the device

30 Normal flora Numbers of bacteria that colonize different parts of the body Numbers per square centimeter of skin surface Hair follicles Sebaceous/Sweat glands Temperature

31 Insertion site colonisation is a major risk factor for CR-BSI 80% of resident and transient skin flora reside in the first 5 cell layers of the epidermis * Does current application methodology ensure that the solution reaches into the cracks and fissures of the epidermal layer? *Hendley JO, Ashe KM. Antimicrob Agents Chemother 1991;35:627-31

32 Care of intravenous devices Contaminated fluid Hub/Port colonization Operators microflora Patients skin microflora Local infection Contaminated on insertion Haematogenous spread Bacteria

33 For Hubs/ Ports Not for skin cleansing Use Povidone-iodine for sensitivity

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37 Saving Lives through Care Bundles Saving Lives Implementation Programme : 1) CVC Care Bundle 2) Peripheral IV Care Bundle 3) Preventing Surgical Site Infection 4) Taking Blood Culture (Best Practice)

38 Peripheral Intravenous Cannula Care Bundle High Impact Intervention(HII) - Elements of the care process:

39 Peripheral Intravenous Cannula Care Bundle High Impact Intervention(HII) - Elements of Care process

40 Central Venous Cannula Care Bundle High Impact Intervention(HII) - Elements of the care process

41 Central Venous Cannula Care Bundle High Impact Intervention(HII) - Elements of the care process

42 Central Venous Cannula Care Bundle High Impact Intervention(HII) - Elements of the care process

43 Summary Infection Prevention Guidelines Infection Prevention Guidelines Handwashing/ANTT Handwashing/ANTT IV Infusion/catheter site prep/care IV Infusion/catheter site prep/care Selection of :~ Catheter Type, Catheter Insertion Site, Sterile transparent semi- permeable film dressing/tape Selection of :~ Catheter Type, Catheter Insertion Site, Sterile transparent semi- permeable film dressing/tape Change administration set (12 or 24 or 72 hrs) Change administration set (12 or 24 or 72 hrs) Rotate peripheral IV cannulae (72hrs) Rotate peripheral IV cannulae (72hrs)

44 Summary Summary Infection Prevention Guidelines Record date of insertion & removal of the device Record date of insertion & removal of the device Keep number of lines, lumens & stopcocks to minimum Keep number of lines, lumens & stopcocks to minimum Maintenance and inspection of I.V. line/site Maintenance and inspection of I.V. line/site Quality control of infusion/additives Quality control of infusion/additives Cleanliness of equipment Cleanliness of equipment

45 References Department of Health (2003) Winning Ways Working together to reduce Healthcare Associated Infection in England (Report from CMO) Department of Health (2003) Winning Ways Working together to reduce Healthcare Associated Infection in England (Report from CMO) Emmerson, A.M. et al. The second national prevalence survey of infection in hospital: overview of results. Journal of Hospital Infection (1996) 32: 3, Emmerson, A.M. et al. The second national prevalence survey of infection in hospital: overview of results. Journal of Hospital Infection (1996) 32: 3, HCA Control of Infection Manual HCA Control of Infection Manual Maki, D.G. and Ringer, M. (1987) Evaluation of dressings regimens for prevention of infection with peripheral venous catheters. J. Am. Med. Ass., 285, Maki, D.G. and Ringer, M. (1987) Evaluation of dressings regimens for prevention of infection with peripheral venous catheters. J. Am. Med. Ass., 285, Weightman N.C et al (1988) Bacteraemia related to indwelling central venous catheters: prevention diagnosis and treatment. Eur. J. of Clin. Microbiol. and Inf. Dis., 7, Weightman N.C et al (1988) Bacteraemia related to indwelling central venous catheters: prevention diagnosis and treatment. Eur. J. of Clin. Microbiol. and Inf. Dis., 7, Little et al. Gloves to fit the bill. Nursing Times (1999) Vol 95 No20, Little et al. Gloves to fit the bill. Nursing Times (1999) Vol 95 No20, Pratt et al. epic 2: National Evidence-Based Guidelines for Preventing Healthcare- Associated infections in NHS Hospitals in England. Journal of Hospital Infection (2007) 65(Supplement 1): February 2007 Pratt et al. epic 2: National Evidence-Based Guidelines for Preventing Healthcare- Associated infections in NHS Hospitals in England. Journal of Hospital Infection (2007) 65(Supplement 1): February 2007 Am J Infect Control 2005;33:83e87 Lobo R, Levin A, Gomes L, et al. Impact of an educational program and policy changes on decreasing catheter associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control 2005;33:83e87 Lobo R, Levin A, Gomes L, et al. Impact of an educational program and policy changes on decreasing catheter associated bloodstream infections in a medical intensive care unit in Brazil. Department of Health. The Health and Social Care Act 2008: Code of Practice for health and social care on the prevention and control of infections and related guidance. Department of Health. London Available Guidance/DH_ Department of Health. The Health and Social Care Act 2008: Code of Practice for health and social care on the prevention and control of infections and related guidance. Department of Health. London Available Guidance/DH_110288

46 Aseptic Non Touch Technique (ANTT) Principles DVD


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