Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &

1. Peripheral line infection - How can we improve? Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre & Beaumont Hospital, Dublin, Ireland

2. HIQA Infection Control Standards • 12 standards • 1. Governance • 2. Implementation of IPC • 3. Infrastructure • 4. HR • 5. Communication • 6. Hand hygiene • 7. Prevention of cross infection • 8. Invasive medical devices • 9. Microbiology laboratories 10. Outbreak management 11. Surveillance 12. AMR .

3. Standard 8: Invasive medical device related infections is prevented /reduced 1. Management in line national/international guidelines, including but not limited to: • Care bundles • Adherence to asepsis and hand hygiene • Daily inspection and review of the need for the device • Systems in place to track the management of the medical device from the date of insertion 2.Staff training (insertion and maintenance) and documentation 3. Regular audit of the use and management of invasive medical devices , with quality improvement actions undertaken to improve service-user care

4. Why bother?

7. 30.8% in 2008 27.7% in 2009 10.8% in 2008 14.5% in 2009

8. 9.3% in 2008 15.0% in 2009 20.9% in 2008 30.0% in 2009

9. Enhanced EARSS 2175 587 98 One in fourS.aureus bacteraemias in Ireland is due to infection associated with a central venous catheter One in twenty S.aureus bacteraemias in Ireland is due to infection associated with a peripheral venous cannula

10. PVC infection – What can we do?

11. Don’t put them in. • Get them out. • Look after them properly.

12. PVCs– 5 things to ask 1. Check the clinical indication why the PVCs is in situ – is it still required?

13. Reasons for PVCs….. • Current IV therapy (medication or infusion) • PVC required for planned clinical procedure (radiology, transfusion etc) • Vascular access required due to unstable condition

14. Mr. Seamus Mc Hugh, Prof. A. Hill, Prof. H Humphreys

15. Why Unnecessary IV Cannula originally placed

16. PVCs– 5 things to ask 2. Remove PVCs where there is extravasation or inflammation

17. PVCs– 5 things to ask 3. Check the PVC dressings are intact

18. Mr. Seamus Mc Hugh, Prof. A. Hill, Prof. H Humphreys

19. PVCs– 5 things to ask 4. Consider removing the PVC if it is in situ longer than 72 hours

20. Mr. Seamus Mc Hugh, Prof. A. Hill, Prof. H Humphreys

21. PVCs– 5 things to ask 5. Perform hand hygiene before and after ALL PVC procedures

22. Audit – Autumn 2009 • ? Clinical indication for PVC • ? Dressing intact • ? Absence of extravasation/inflammation • ? Not in longer than 72 hours and if so good reason for it Dr. Meghan Finan Ms. Valerie Caffrey, Mr. Toney Thomas Mr. John Walsh, Dr. Fidelma Fitzpatrick Staff of Banks/CCU/Corrigan

23. Results • Compliance (should be 100%) • 86% on the medical wards (range 55-100%) • 72% on the surgical ward (range 50-100%) • The target of 100% compliance was reached on… • 3 occasions (surgical ward) • 10 occasions (medical wards)

25. What can we do?

26. Don’t put them in. • Get them out. • Look after them properly.

27. 5 things –Every day on ward rounds • ? Clinical indication for PVC • ? Dressing intact • ? Absence of extravasation/inflammation • ? Not in longer than 72 hours and if so good reason for it • Hand hygiene before and after PVC insertion / manipulation

28. Lets avoid this….