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IV Medicine Administration: Infection Control

IV Medicine Administration: Infection Control. September 2009. 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.

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IV Medicine Administration: Infection Control

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  1. IV Medicine Administration: Infection Control September 2009

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

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

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

  13. Administration Additive/solutions 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 • Vascular access device - send tip to microbiology for culture. • Inform medics • Document all observations and interventions Systemic - as above • Vital Signs observations • Inform medics • Document all observations and interventions Treatment dependent on individual, presentation and causative organisms isolated

  17. 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

  18. 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.

  19. Treatment • Stop the infusion - inform medical staff • Send blood cultures & swab from site • Monitor vital signs • Remove the line - send tip to microbiology for culture

  20. 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

  21. Documentation • Document all IV sites 12 hourly (once per shift) • Nursing Notes • Patient Care Plans • Documentation is evidence that assessment has been carried out

  22. 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 • Holistic assessment of the patient and monitored as required to meet individual needs as per local policies using assessment tools (MEWS/SEWS) • Accurate documentation is essential

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