1.
Welcome
Dr. Eleri Davies, Faculty Lead HCAI

2. If we can improve
care for one patient,
then we can do it for ten.
If we can do it for ten,
then we can do it for 100.
And if we can do it for 100,
we can do it for a 1,000 ……………………PLUS

3. Common HCAIs Gastro-intestinal infections 20.6%
Urinary Tract Infection 19.9%
Surgical Site Infection 14.5%
Pneumonia %
Skin and Soft Tissue 10.4%
Primary Blood stream 7%
E.T.M. Smyth et al (2008) Journal of Hospital Infection 69:

4. Bacteraemia surveillance “Top 10” - 2009
Rank
Organism
Rate per 100,000 bed days 1
Escherichia coli (E.coli) 51 2
Staphylococcus aureus (MSSA) 18 3
Enterococcus species 13 4
Klebsiella species 10
= 5
Coagulase-negative Staphylococcus 9 =5
Streptococcus pneumoniae 7
Staphylococcus aureus (MRSA)  8
Pseudomonas aeruginosa 5 =9
Proteus species
Serratia species

6. Infection Risks of Medical Devices
Breach of normal defences
Skin
Urinary tract – urine flow
Device Factors
Materials – plastics
Manipulation
Administration of drugs
Connection of giving sets
Sampling
Healthcare Factors
Resistant organisms within hospital environment
Hand hygiene standards of care givers
Insertion and maintenance practices
Patient associated risk factors
Debilitated patients
Chronic diseases
Immunosuppression

7. Urinary Catheters
Kass (1950s) 2-4% infections post single catheterisation.
Brumfitt (1961) 9.1% infection rate in following single catheterisation in healthy women, 22.8% infection rate in difficult obstetric cases.

8. Prevalence – Acute 2006 5734 adult in-patients surveyed
25% had an urinary catheter in situ or removed within the previous 7 days
1.7% of catheterised patients had a UTI
E.T.M. Smyth et al (2008) Journal of Hospital Infection 69:

9. Prevalence – Long Term Care Facilities
HALT prevalence study – July – August 2010
895 residents surveyed across Wales
9% (80pts) had urinary catheters present on the day of the survey
6% (5pts) of catheterised patients had a CAUTI
Personal Communication – Dafydd Williams HALT prevalence survey 2010

10. Peripheral Vascular Cannulae
Widely used since 1960s / 70s
0.2 infections per 1000 PV catheter days
McLaws M L, Taylor PC. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. Journal of Hospital Infection 2003, 53:259–267

11. Local Complications
Extravasation of chemicals
Local skin and soft tissue infections
Leading to Blood stream infections in some

12. Increasing advances and complexity of therapies have resulted in increasing use of medical devices.
Infection is an unwanted and often avoidable consequence of the use of medical devices.
Ensuring evidence based practice is in routine use when medical devices are used will assist in our aim of reducing HCAI……………

13. …………….Care Bundles for Insertion and Maintenance of Medical Devices
Starting with
Urinary Catheter Care Bundles
Peripheral Line Care Bundles
Roll out of Central Line Care Bundles beyond critical care

14. Today’s Aim To review progress with Urinary Catheter Care Bundle
Introduce the plan for implementing the Peripheral Vascular Cannula Care Bundle.