1. Infection Control: IV Drug Administration

2. 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.

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

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

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

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

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

8. 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

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

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

11. 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

12. 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

13. 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

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

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

16. 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.

18. 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

19. 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.

20. 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.

21. 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

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

23. 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