Infection Control: IV Drug Administration

Learning outcomes Explain 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.

Chain of Infection – Administration of IV Therapy Reservoir Infectious Agent/Organism Means of Exit Route of Transmission Means of Entry Susceptible Host

Infectious Micro-organisms associated with IV therapy Staphylococcus epidermidis Staphylococcus aureus Enterococcus spp. Klebsiella Pseudomonas E. Coli Serratia Candida

Reservoirs Patients Skin – resident microflora Environment Equipment IV Solutions & drugs HCW Hands -Transient microflora

Means of Exit Secretions such as bodily fluids e.g. blood Skin such as skin scales

Route of Transmission Direct contact - on healthcare workers hands Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates Puncture of skin (inoculation / blood borne)

Means of entry Operator’s microflora Contaminated fluid Patient’s skin microflora Local infection Migration down catheter inside and out Contaminated on insertion Haematogenous spread

Susceptible Host Extremes of age Surgery Extended length of stay in hospital Compromised immune system Chronic disease Antibiotics Vascular access device in-situ

Standard Precautions The minimal level of infection control precautions that apply in all situations.

2 There are 10 elements to Standard Precautions PPE Hand Hygiene Clinical waste 2 Patient Care Equipment There are 10 elements to Standard Precautions Linen Occupational Exposure Isolation Environment Spillages Cough etiquette

Preparation Clean Work Surface Hand Decontamination Reconstitution Patient Preparation- explanation/skin Venous access preparation Remember if you are disturbed you need to decontaminate your hands again

Administration Additive/solutions Packaging Intact Expiry date Always check: Packaging Intact Expiry date Particulate Matter Glass for cracks Bolus/flushes Always: Clean the port thoroughly Where possible use needle free connector

Detection of Infection Infection can present in a number of ways: Local Site Infection Microbial Phlebitis Systemic Infection

Inspection At set Intervals, inspect for signs of local infection & phlebitis: Tenderness Erythema Swelling Purulent Discharge Palpable Venous cord

Suspected Cannula Infection/ Phlebitis Local- stop infusion, swab site if discharge visible if central or arterial line - send tip to microbiology for culture. Inform medics Systemic- as above, Vital Signs observations inform medics. Treatment dependent on individual, presentation, and causative organisms isolated.

Giving sets Change giving set after administration of blood or blood products either every 12 hours or when the transfusion is complete After 24 hours of TPN administration After 72 hours if clear fluids are used All ward prepared infusions should be changed after 24 hours

Infusate Sepsis 10 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.

Treatment 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.

Dressings Function of the dressing is: To protect the site of venous access To stabilise the catheter in place Prevent mechanical damage Keep site clean

Documentation Document all IV sites daily Nursing Notes Care Plans Daily documentation is evidence that assessment has been carried out

Key Points Intravenous drug administration if not done properly can cause infection Hand hygiene, aseptic technique, correct preparation and administration of iv.drugs/solutions and line changes will minimise the risk of infection Patients should be closely monitored for signs of infection Good documentation is essential