IV Medicine Administration: Infection Control September 2009.

IV Medicine Administration: Infection Control

September 2009

February 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.

February 2009 3

Chain of Infection –Administration of IV

Therapy

Reservoir

Infectious Agent/Organism

Means of Exit

Route of Transmission

Means of Entry

Susceptible Host

February 2009 4

• Staphylococcus epidermidis • Staphylococcus aureus• Enterococcus spp. • Klebsiella• Pseudomonas• E. Coli• Serratia• Candida

Infectious Micro-organisms associated with IV therapy

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Reservoirs

• Patients Skin – resident microflora

• Environment

• Equipment

• IV Solutions & drugs

• HCW Hands -Transient microflora

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Means of Exit

• Secretions such as bodily fluids e.g. blood

• Skin such as skin scales

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Route of Transmission

• Direct contact - on healthcare workers hands

• Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates

• Puncture of skin (inoculation / blood borne)

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Means of entry

Contaminated on insertion

Contaminated fluid

Patient’s skin

microflora

Local infection

Operator’s microflora

Haematogenous spread

Migration down catheter inside and out

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Susceptible Host

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

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Standard Precautions

The minimal level of infection control precautions that apply in

all situations.

February 2009 11Isolation

There are 9 elements to Standard Precautions

Hand Hygiene

PPE

Clinical waste

Linen

SpillagesOccupational Exposure

Environment

Patient Care Equipment

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Preparation

• Clean Work Surface• Hand

Decontamination • Reconstitution• Patient Preparation-

explanation/skin• Venous access

preparationRemember if you are interrupted you need to

decontaminate your hands again

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AdministrationAdditive/solutionsAlways check:

• Packaging Intact• Expiry date• Particulate Matter• Glass for cracks

Bolus/flushesAlways:

• Clean the port thoroughly

• Where possible use needle free connector

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Detection of Infection

Infection can present in a number of ways:

• Local Site Infection • Microbial Phlebitis• Systemic Infection

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Inspection

At set Intervals, inspect for signs oflocal infection & phlebitis:

1. Tenderness2. Erythema3. Swelling4. Purulent Discharge5. Palpable Venous cord

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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

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Phlebitis Scale (Jackson 1998)

IV site appears healthy

One of the following is evident:•Slight pain near IV site

OR•Slight redness near IV site

TWO of the following signs are evident:•Pain at IV site•Erythema•Swelling

ALL of the following signs are evident:•Pain along path of cannula•Erythema•Induration

ALL of the following signs are evident & extensive:•Pain along path of cannula•Erythema & Induration•Palpable Venous Cord

ALL of the following signs are evident & extensive:•Pain along path of cannula•Erythema & Induration•Palpable venous cord & Pyrexia

Early Stage of Phlebitis

RESITE CANNULA

Medium stage of Phlebitis

RESITE CANNULACONSIDER TREATMENT

Advanced stage of phlebitis or the start of thrombophebitis

RESITE CANNULACONSIDER TREATMENT

Advanced stage of Thrombophebitis

INITIATE TREATMENT RESITE CANNULA

Possibly first signs of Phlebitis

OBSERVE CANNULA

No Signs of Phlebitis

OBSERVE CANNULA0

1

22

3

4

45

February 2009 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

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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.

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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

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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

February 2009 22

Documentation

• Document all IV sites 12 hourly (once per shift)

• Nursing Notes

• Patient Care Plans

• Documentation is evidence that assessment has been carried out

February 2009 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

• 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