06.12.2010 Welcome Dr. Eleri Davies, Faculty Lead HCAI

If we can improve care for one patient, then we can do it for ten. If we can do it for ten, then we can do it for 100. And if we can do it for 100, we can do it for a 1,000 ……………………PLUS

Common HCAIs Gastro-intestinal infections 20.6% Urinary Tract Infection 19.9% Surgical Site Infection 14.5% Pneumonia 14.1% Skin and Soft Tissue 10.4% Primary Blood stream 7% E.T.M. Smyth et al (2008) Journal of Hospital Infection 69:230 - 248

Bacteraemia surveillance “Top 10” - 2009 Rank Organism Rate per 100,000 bed days 1 Escherichia coli (E.coli) 51 2 Staphylococcus aureus (MSSA) 18 3 Enterococcus species 13 4 Klebsiella species 10 = 5 Coagulase-negative Staphylococcus 9 =5 Streptococcus pneumoniae 7 Staphylococcus aureus (MRSA)  8 Pseudomonas aeruginosa 5 =9 Proteus species Serratia species

Infection Risks of Medical Devices Breach of normal defences Skin Urinary tract – urine flow Device Factors Materials – plastics Manipulation Administration of drugs Connection of giving sets Sampling Healthcare Factors Resistant organisms within hospital environment Hand hygiene standards of care givers Insertion and maintenance practices Patient associated risk factors Debilitated patients Chronic diseases Immunosuppression

Urinary Catheters Kass (1950s) 2-4% infections post single catheterisation. Brumfitt (1961) 9.1% infection rate in following single catheterisation in healthy women, 22.8% infection rate in difficult obstetric cases.

Prevalence – Acute 2006 5734 adult in-patients surveyed 25% had an urinary catheter in situ or removed within the previous 7 days 1.7% of catheterised patients had a UTI E.T.M. Smyth et al (2008) Journal of Hospital Infection 69:230 - 248

Prevalence – Long Term Care Facilities HALT prevalence study – July – August 2010 895 residents surveyed across Wales 9% (80pts) had urinary catheters present on the day of the survey 6% (5pts) of catheterised patients had a CAUTI Personal Communication – Dafydd Williams HALT prevalence survey 2010

Peripheral Vascular Cannulae Widely used since 1960s / 70s 0.2 infections per 1000 PV catheter days McLaws M L, Taylor PC. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. Journal of Hospital Infection 2003, 53:259–267

Local Complications Extravasation of chemicals Local skin and soft tissue infections Leading to Blood stream infections in some

Increasing advances and complexity of therapies have resulted in increasing use of medical devices. Infection is an unwanted and often avoidable consequence of the use of medical devices. Ensuring evidence based practice is in routine use when medical devices are used will assist in our aim of reducing HCAI……………

…………….Care Bundles for Insertion and Maintenance of Medical Devices Starting with Urinary Catheter Care Bundles Peripheral Line Care Bundles Roll out of Central Line Care Bundles beyond critical care

Today’s Aim To review progress with Urinary Catheter Care Bundle Introduce the plan for implementing the Peripheral Vascular Cannula Care Bundle.