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Transcript
Prevention of
Intravascular
Device-Associated
Infections
1. Describe the relevance and impact of
intravascular Device-Associated infections.
2. Identify infection sources and routes of
transmission for intravascular infections.
3. Outline the main recommendations to
prevent those infections.
December 1, 2013
Learning objectives
2
• 30 minutes
December 1, 2013
Time involved
3
• Intravenous (IV) infusions among the
commonest invasive procedures (peripheral or
central)
• IV central catheters are the main source of
bloodstream infection (CLABSI)
• Infections associated:
December 1, 2013
Introduction
• Cellulitis, abscess, thrombophlebitis, bacteraemia,
endocarditis
• Principles to prevent infections similar for central
and peripheral catheters
4
• Strict asepsis for insertion and maintenance of
catheters
• Insertion site dry and protected with a sterile dressing
• No touch technique
• IV line secure without movements
• Closed system
• Inspection of the insertion site daily
• Remove the catheters as soon as possible
• No reuse of catheters intended for single use
• Healthcare personnel educated and their knowledge
assessed
• Alternative routes for hydration or parenteral therapy
December 1, 2013
Key points
5
December 1, 2013
Sites of possible contamination of
intravascular infusions
6
• Sources of contamination intrinsic or extrinsic
• Most microorganisms from the patient’s skin
flora
• Contamination of device hub also a source of
infection
• S. aureus - 60 to 90% of infections
December 1, 2013
Sources and Routes of
Transmission - 1
7
Hands of staff
Contamination of fluids
Skin flora
Flora del
paciente
December 1, 2013
Sources and Routes of
Transmission - 2
Contamination of
insertion site
Injections ports
Contaminación de las
conexiones
8
Seed from
distant site
Main source of
infection
Prevention
Infusion fluids
Monitor sterilisation
Ensure fluid is pyrogen free.
Avoid damage to containers
Inspect containers
Addition of
medications
Aseptic technique
Sterile medications
Carry out procedures in the pharmacy.
Sterile device for accessing the system.
Single-dose vials
If multi-dose vials have to be used:
Refrigerate after opening
Wipe diaphragm with 70% isopropanol
Warmingcontainer
Ensure no contamination
Dry warming systems are preferred.
December 1, 2013
Prevention of Infections - 1
9
Main source of
infection
Prevention
Insertion of
catheter
Thorough hand disinfection and sterile gloves
Thoroughly disinfect the skin insertion site.
Catheter site
Cover with sterile dressing
Remove catheter if signs of infection occur.
Inspect site every 24 hours.
Change dressing only when necessary.
Do not use antimicrobial ointments.
Injection ports
Clean with 70% isopropanol and allow to dry
Close ports that are not needed with sterile stopcocks.
Changing of
infusion set
Replace no more frequently than 72 hours (blood and lipids
every 24 hours).
Thorough hand disinfection
Use good aseptic technique.
December 1, 2013
Prevention of Infections - 2
10
• Routine changes of peripheral IV catheters not
required
• In adults recommendation to change every 72-96 hours to
reduce phlebitis
• In children should not be replaced routinely
December 1, 2013
General Comments - 1
• Routine replacement of central catheters not
necessary
• Central catheters used only when indicated
• Non-essential catheters removed
• Risk of infection increases with length of
catheterisation
11
• Teflon or polyurethane catheters associated with
fewer infections
• Steel needles same rate of infection as Teflon
catheters
December 1, 2013
General Comments - 2
• Steel needles complicated by infiltration of IV fluids
• Well-trained staff to set up and maintain infusions
• Masks, caps, and gowns not necessary for insertion
of peripheral IV lines
• Use of non-sterile barriers will protect the operator if
blood exposure likely
12
•
•
•
•
•
•
Place arm on a clean sheet or towel
Hand hygiene (alcohol hand rub or antiseptic soap)
Dry hands on a paper or unused linen towel
Hand hygiene (gloves does not replace it)
Not remove hair (if necessary clip, avoid shaving)
Disinfect skin site, apply for 30 seconds and allow drying
December 1, 2013
Protocol for peripheral
infusions - 1
• 0.5% chlorhexidine-alcohol, 2% tincture of iodine, 10% alcoholic
povidone-iodine, or isopropanol).
• Chlorhexidine products should not be used in
children younger than 2 months
13
• Cannula preferably in an upper limb
• Secure sterile dressing
• Transparent dressings allow inspection of the site
December 1, 2013
Protocol for peripheral
infusions - 2
• Secure cannula, label with insertion date
• Assess need for catheter every 24 hours
• Inspect catheter daily
• Avoid cut downs, especially in the leg
• Cannulae and sets must be sterile
14
• Selection of site
• Higher infections for jugular and femoral
• Maximum barriers
• Disinfect skin with 2% chlorhexidine/alcohol
• Change transparent dressings once a week or if soiled,
loose, or damp, gauze every two days
• Replace sets not for blood or lipids no more than 72 hours
December 1, 2013
Additional guidelines for
central catheters
15
• Systemic antibiotic prophylaxis
• Topical use of antimicrobial ointments
• Routine replacement of central venous catheters
• Routine use of antibiotic locks for central venous
catheters
• Routine use of in-line filters
December 1, 2013
Measures that should not be
considered as part of a general
prevention policy:
16
• Marschall J, et al. Strategies to prevent central lineassociated bloodstream infections in acute care
hospitals. Infect Control Hosp Epidemiol 2008; 29(suppl.
1): S22-S30.
http://www.jstor.org/stable/10.1086/591059
• Marchaim D, et al. Epidemiology of bacteraemia
episodes in a single center: increase in Gram-negative
isolates, antibiotics resistance, and patient’s age. Eur J
Clin Microbiol Infect Dis 2008; 27:1045-51.
• Standards for infusion therapy. Royal College of Nursing,
2010.
http://www.rcn.org.uk/__data/assets/pdf_file/0005/785
93/002179.pdf
December 1, 2013
References - 1
17
• Marschall J. Catheter-associated bloodstream-infections:
Looking outside of the ICU. Am J Infect Control 2008;
36:172.e5-8.
• Collignon PJ, et al. Intravascular catheter bloodstream
infections: an effective and sustained hospital-wide
prevention program for 8 years. Med J Austr 2007;
187:551-554.
• Guidelines for the Prevention of Intravascular CatheterRelated Prevention of Intravascular Device-Associated
Infections Infections, 2002. MMWR 2002; 51:1-26.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110
a1.htm
December 1, 2013
References - 2
18
1.
2.
IV central catheters are the main source of bloodstream
infection . T/F?
The main strategy to prevent CLABSI is
a)
b)
c)
d)
3.
Avoid unnecessary catheters
Good selection of insertion site
Teflon catheters
Change peripheral catheters every 72 hours
December 1, 2013
Quiz
Which measure should not be considered to prevent
intravascular infections?
a)
b)
c)
d)
Aseptic technique in insertion and maintenance of catheters
Skin antisepsis with 2% chlorhexidine/alcohol
Routine replacement of central venous catheters
Maximum barriers for insertion of central catheters
19
• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
December 1, 2013
International Federation of
Infection Control
20