2Learning outcomesExplain the chain of infection and standard precautions.To understand the application of the chain of infection and standard precautions in relation to IV therapy.Discuss the actions required to prevent/minimise the risk of infection in a patient receiving IV drug/fluid therapy.Describe how vascular access device related infections can be detected.
3Chain of Infection – Administration of IV Therapy ReservoirInfectious Agent/OrganismMeans of ExitRoute of TransmissionMeans of EntrySusceptible Host
4Infectious Micro-organisms associated with IV therapy Staphylococcus epidermidisStaphylococcus aureusEnterococcus spp.KlebsiellaPseudomonasE. ColiSerratiaCandida
6Means of Exit Secretions such as bodily fluids e.g. blood Skin such as skin scales
7Route of Transmission Direct contact - on healthcare workers hands Indirect contact- contaminated equipment, fluids, parenteral drugs or infusatesPuncture of skin (inoculation / blood borne)
8Means of entry Operator’s microflora Contaminated fluid Patient’s skin microfloraLocal infectionMigration down catheter inside and outContaminated on insertionHaematogenous spread
9Susceptible Host Extremes of age Surgery Extended length of stay in hospitalCompromised immune systemChronic diseaseAntibioticsVascular access device in-situ
10Standard PrecautionsThe minimal level of infection control precautions that apply in all situations.
112 There are 10 elements to Standard Precautions PPE Hand Hygiene Clinical waste2Patient Care EquipmentThere are 10 elements to Standard PrecautionsLinenOccupational ExposureIsolationEnvironmentSpillagesCough etiquette
12Preparation Clean Work Surface Hand Decontamination Reconstitution Patient Preparation- explanation/skinVenous access preparationRemember if you are disturbed you need to decontaminate your hands again
13Administration Additive/solutions Packaging Intact Expiry date Always check:Packaging IntactExpiry dateParticulate MatterGlass for cracksBolus/flushesAlways:Clean the port thoroughlyWhere possible use needle free connector
14Detection of Infection Infection can present in a number of ways:Local Site InfectionMicrobial PhlebitisSystemic Infection
15Inspection At set Intervals, inspect for signs of local infection & phlebitis:TendernessErythemaSwellingPurulent DischargePalpable Venous cord
16Suspected Cannula Infection/ Phlebitis Local-stop infusion,swab site if discharge visibleif central or arterial line - send tip to microbiology for culture.Inform medicsSystemic-as above,Vital Signs observationsinform medics.Treatment dependent on individual, presentation, and causative organisms isolated.
18Giving setsChange giving set after administration of blood or blood products either every 12 hours or when the transfusion is completeAfter 24 hours of TPN administrationAfter 72 hours if clear fluids are usedAll ward prepared infusions should be changed after 24 hours
19Infusate Sepsis10 hours after infusion 3 commenced patient spiked a temp.Patient pulled out cannula.Cannula resited same infusion recommenced.Temp spiked again, blood cultures taken.Environmental Pseudomonas sp isolated from blood.
20Treatment Stop the infusion - inform medical staff Send the infusate to microbiology for culture.Send blood cultures & swab from site.Monitor vital signs.Remove the line - send tip to microbiology for culture.
21Dressings Function of the dressing is: To protect the site of venous accessTo stabilise the catheter in placePrevent mechanical damageKeep site clean
22Documentation Document all IV sites daily Nursing Notes Care Plans Daily documentation is evidence that assessment has been carried out
23Key PointsIntravenous drug administration if not done properly can cause infectionHand hygiene, aseptic technique, correct preparation and administration of iv.drugs/solutions and line changes will minimise the risk of infectionPatients should be closely monitored for signs of infectionGood documentation is essential