Infection Control: Venepuncture and Cannulation Insertion and Maintenance

1. Infection Control:Venepuncture and Cannulation Insertion and Maintenance

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 venepuncture and cannulation. • Discuss the actions required to prevent/minimise the risk of infection in a patient having venepuncture and cannulation. • Describe how vascular access device related infections can be prevented • Describe how vascular access device related infections can be detected.

3. Risky Business • High Complication Rate • Under reporting • Compromises patient treatment • Extends treatment duration • Endangers patient survival • Includes risks to healthcare workers • Costs millions of pounds annually

4. One study of PVC’s • 52% Of patients had a PVC • 33% Of PVCs were incorrectly dressed • 52% Of PVCs were incorrectly positioned • 46% Of PVCs were unused for 24 hours • 23% Of PVCs had never been used • 23% Of PVCs had no documented purpose • 12% Of PVCs had visible phlebitis • 6% Of PVCs had infiltration • Thomas et al JHI 2006

5. The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism

6. Infectious Micro-organisms associated with Venepuncture and Cannulation • Staphylococcus epidermidis • Staphylococcus aureus • Enterococcus spp. • Klebsiella • Pseudomonas • E. Coli • Serratia • Candida

7. We cannot identify all patients with BBV • 20% of patients with AIDS present without anyone ever knowing they were HIV positive

8. BBV – The facts Newly diagnosed per year: HIV = 250 HBV = 350 HCV = 917 Risk of transmission from sharps injury: HIV = 0.3% (1:300) HBV = 20-40% (1:3) HCV = 3-5% (1:30) Incubation period: HIV = 15yrs HBV = varies HCV = 20yrs plus

9. The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism Reservoir

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

12. The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism Reservoir Means of Exit

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

14. The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism Reservoir Means of Exit Route of Transmission

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

16. The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism Reservoir Means of Entry Means of Exit Route of Transmission

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

18. Infectious Agent/Organism Susceptible Host Reservoir Means of Entry Means of Exit Route of Transmission The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance

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

20. Infectious Agent/Organism Susceptible Host Reservoir Means of Entry Means of Exit Route of Transmission The Chain of Infection –Venepuncture and Cannulation Insertion and Maintenance

21. Preparation • Clean Work Surface • Hand Decontamination • Skin prep • Tourniquets Remember if you are disturbed you need to decontaminate your hands again

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

23. PPE Hand Hygiene Clinical waste Patient Care Equipment 2 Linen Isolation Occupational Exposure Environment Spillages There are 9 elements to Standard Precautions

24. Aseptic Non Touch Technique • The overriding and basic principle is that the susceptible site should not come into contact with any item that is not sterile. • What are the susceptible site(s) on these pieces of equipment

25. 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

26. Maintenance

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

29. Inspection Cannula must be inspected and findings documented at least once per shift • Is vascular access still necessary? • How long has it been in ? • Is the dressing dry and intact ? • Is the cap on and locked ? 5. Check for phlebitis

30. Giving Sets • Change giving set after administration of blood or blood products either every 12 hours or when 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

31. 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.

32. Prevention – Best practice • Do not use the top port • “SCRUB THE HUB” pre and post use • Use needle free device with extension

33. Removal of the Cannula • Wash your hands • Wear gloves • Use sterile gauze • Apply pressure for approx 2-3 minutes • Inspect the cannula to ensure it is complete and undamaged • Dispose of cannula into sharps bin • Wash your hands!!!! • DOCUMENT

34. Key Points • Venepuncture/cannulation if not done properly can cause infection • Hand hygiene, aseptic technique and correct preparation will minimise the risk of infection • Patients should be closely monitored for signs of infection • Good documentation is essential • If it is not documented it is not done!!