Peripheral Vascular Cannulas so far …….. Meleri Jenkins Infection Prevention and Control Nurse Hywel Dda Health Board

Point Prevalence Study Carmarthen Division No CAUTI 3 PVC infections

Peripheral Vascular Catheters ‘The greatest risk factor for developing a bacteraemia is an indwelling intravascular catheter’ Duerden 2007 ‘At any one time 61% of hospital patients will have a peripheral intravenous catheter’ 2006 HCAI Prevalence Survey

Routes of access of causative microorganisms Intraluminal migration Extraluminal migration Contaminated catheter hub - Patients skin flora - HCP hands Skin organisms - Patients skin flora - HCP hands - Contaminated disinfectant 60% 12% <1% Contaminated infusates Contaminated infusate - Extrinsic (Fluid, Medication) - Intrinsic (Manufacturer) Insertion site colonisation Unknown – Local infection and heamatogenous seeding as well as 1,2,3. So how do the microorganisms gain access to the catheter to initiate infection? By gaining access to the extraluminal or intraluminal surface of the device where they become incorporated into a biofilm that allows sustained infection and haematogenous dissemination . Contamination from fluid infused/administered through the device is rare and is the most likely cause of epidemic BSIs but catheter related infections are the cause of most endemic BSIs. Microorganisms gain access by one of the three following mechanisms 1) the microorganisms may be impacted during catheter insertion, invading the percutaneous tract. 2) Microorganisms contaminate the catheter hub (and lumen) 3) organisms are carried haematogenously to the implanted IVD from remote sources of infection, eg pneumonia. Unknown = 28% Haematogenous seeding from distant infection Impaction during insertion Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med 2004;30:62-7.

Insertion poor skin disinfection no documentation no date of insertion no accountablity

Skin Disinfection Choices 2% chlorhexidine in 70% Isopropyl Alcohol Povidone iodine solution

Skin Disinfection DOH Guidelines – UK, February 2007 Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

PLAN Introduce Chloraprep Sepp (2%Chlorhexidine in 70%Alcohol) Insertion Bundle Sticker Pilot at 2 Ward areas in Prince Phillip Hospital – identify ward champion Ward 1 / SSU Ward 4

ChloraPrep 1.5ml Frepp ChloraPrep 0.67ml Sepp Coverage area: 10 x 13 cm For procedures such as: Blood culture collections Peripheral canulation AV fistula and ‘portacath’ access Simple biopsies and minor procedures ChloraPrep 0.67ml Sepp Coverage area: 5 x 8 cm For procedures such as: Peripheral canulation Surgical pin site cleansing Subcutaneous device insertions Always allow the prepped area to air dry completely before carrying on with any procedure

Peripheral Vascular Cannula - Insertion Bundle Sticker

Saving Lives – HII, Peripheral Vascular Catheters

Visual Infusion Phlebitis Score

Study Audit after 4 weeks Number of PVC’S on ward Length insitu Vascular Infusion Phlebitis Score Use of Insertion Bundle Sticker Cost of introducing Chloraprep

Act Review/Amend use of sticker Review use of Daily Data Sheet Look at introducing a PVC Maintenance Bundle into the Nursing Careplan Rollout - Prince Phillip Hospital early 2011, follow through to the rest of the Health Board