Download 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.
• 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
2
Chain of Infection –
Administration of IV Therapy
Infectious Agent/Organism
Susceptible Host
Reservoir
Means of Entry
Means of Exit
Route of Transmission
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3
Infectious Micro-organisms
associated with IV therapy
•
•
•
•
•
•
•
•
Staphylococcus epidermidis
Staphylococcus aureus
Enterococcus spp.
Klebsiella
Pseudomonas
E. Coli
Serratia
Candida
February 2009
4
Reservoirs
• Patients Skin – resident microflora
• Environment
• Equipment
• IV Solutions & drugs
• HCW Hands -Transient microflora
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5
Means of Exit
• Secretions such as bodily fluids e.g.
blood
• Skin such as skin scales
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6
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
Operator’s
microflora
Patient’s skin
microflora
Local
infection
Contaminated
fluid
Migration down
catheter inside and out
Contaminated
on insertion
February 2009
Haematogenous
spread
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Susceptible Host
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•
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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.
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10
PPE
Hand Hygiene
Clinical waste
There are 9 elements to
Standard Precautions
Patient Care
Equipment
Linen
Isolation
February 2009
Environment
Occupational
Exposure
11
Spillages
Preparation
• Clean Work Surface
• Hand
Decontamination
• Reconstitution
• Patient Preparationexplanation/skin
• Venous access
preparation
Remember if you are interrupted you need to
decontaminate your hands again
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12
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
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13
Detection of Infection
Infection can present in
a number of ways:
• Local Site Infection
• Microbial Phlebitis
• Systemic Infection
February 2009
14
Inspection
At set Intervals, inspect for signs of
local infection & phlebitis:
1.
2.
3.
4.
5.
Tenderness
Erythema
Swelling
Purulent Discharge
Palpable Venous cord
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15
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 and16
causative organisms isolated
February 2009
Phlebitis Scale (Jackson 1998)
IV site appears healthy
0
One of the following is evident:
•Slight pain near IV site
OR
•Slight redness near IV site
1
TWO of the following signs are evident:
•Pain at IV site
•Erythema
•Swelling
22
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
February
2009
•Erythema
& Induration
•Palpable venous cord & Pyrexia
No Signs of Phlebitis
OBSERVE CANNULA
Possibly first signs of Phlebitis
OBSERVE CANNULA
Early Stage of Phlebitis
RESITE CANNULA
Medium stage of Phlebitis
3
RESITE CANNULA
CONSIDER TREATMENT
Advanced stage of phlebitis or the start of thrombophebitis
4
45
RESITE CANNULA
CONSIDER TREATMENT
Advanced stage of Thrombophebitis
INITIATE TREATMENT
RESITE CANNULA
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
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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
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•
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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
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Documentation
• Document all IV sites 12 hourly (once per
shift)
• Nursing Notes
• Patient Care Plans
• Documentation is evidence that assessment
has been carried out
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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
February 2009
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