Infections and IV Tubing Johanna Dalton Missy Leppard Leslie Martino

ACH Policy Standard precautions will be used at all times. Tubing’s will be dated and timed after each change. Primary and secondary IV tubing will be changed every 72 hours and prn. Why 72 hours?

Definitions Infection—the invasion of the body by pathogenic microorganisms that reproduce and multiply causing disease and tissue damage Nosocomial infection--an infection that is acquired as a result of exposure to a microorganism in a hospital setting

Nosocomial Infections There are 2 million nosocomial infections yearly Approximately 850,000 of these infections are catheter/IV related There is a 20% fatality rate with regard to catheter infections CDC’s response—founded the National Nosocomial Infection Surveillance Program which is an ongoing collaborative surveillance system to obtain national data on nosocomial infections

Major complication with Infection #1 Staph Infections Staphylococcus aureus and enterococcus Both of these staph infections are subject to antibiotic resistance Examples of antibiotic resistant infections are MRSA and VRE WHAT CAN WE DO?

Infection Prevention #1 HANDWASHING—before and after tubing changes, before accessing the hub #2 SCRUB THE HUB—15 seconds with alcohol before accessing the hub #3 GLOVES—wear clean gloves when accessing the hub #4 TUBING—change tubing no more frequently than 72 hours #5 BASIC CARE—keep all wounds covered, keep patient clean from urine and feces, keep the tubings off the floor

Question What are three ways the nurse can help prevent infection? can help prevent infection?

History of IV Tubing Changes The practice of routinely changing IV administration sets was NOT evidence based practice. Prior to the 1970s, IV sets were used until they malfunctioned or were not required During the 70s an epidemic of catheter-related bacteremia occurred—24 hr change of sets and fluid was implemented This change was universally implemented EVEN THOUGH the cause of the problem was unrelated (manufacturer- contaminated fluid)

Evidence Based Practice According to the CDC, iv tubing and sets should be changed no more frequently than hours Data from these studies reveal that replacing administration sets/iv tubing no more frequently than 72–96 hours after initiation of use is safe and cost-effective (this relates specifically to fluids commonly used on hospital floors such as normal saline, D5W). More recent studies suggest that administration sets may be used safely for up to 7 days if used in conjunction with antiseptic catheters or if fluids that enhance microbial growth (e.g., parenteral nutrition or blood) have not been used.

Question What is the CDC’s current policy regarding tubing changes?

So…which is better? hours with 96 being the preferred time frame Misinterpretation of the CDC’s recommendation— “no more frequently than 72hrs” has been loosely translated as no longer than 72hrs. has been loosely translated as no longer than 72hrs. This is incorrect! 72 hours is NOT the MAXIMIM amount of time but rather the MINIMUM amount of time the tubing should be kept in place Prolonged use of IV tubing does not increase the risk of infection Tubing changes between day 4 (96 hrs) and day 7 (168 hrs)have been found to be equivalent to changes at day 3 (72hrs)

Just the Facts… ENSURE aseptic technique is used and enforced at your agency…wash your hands, wear gloves, and scrub the hub Until more studies are done, the burden falls on the HCP to protect the patient from catheter/tubing infections 3 Year Study in Australia of 6500 patients—began in 2011—that will study infection and cost benefits of less frequent changes of IV tubing

Resources Center for Disease Control and Prevention. (2011). Guidelines for the Prevention of Intravascular Catheter-Related Infections, Retrieved from, guidelines/bsi-guidelines-2011.pdf, Change iv tubing less often. (2011, October). Australian Nursing Journal, 19, (4), 22. Lewis, L. L., Dirksen, S. R., Heitkemper, M. M., Bucher, & L., Camera, I. M. (2011). Medical surgical nursing: assessment and management of clinical problems. St. Louis: Elsevier Mosby. Peripheral Intravenous Therapy Guidelines. (2010, July). Auburn Memorial Hospital. Peripheral Intravenous Therapy Guidelines. (2010, July). Auburn Memorial Hospital. Preventing catheter related bloodstream infection. (2005, September). American Association of Critical-Care Nurses. Rickard, C. M., Lipman, J., Courtney, M., Siversen, R., & Daley, P. (2004). Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters. Infection Control and Hospital Epidemiology, 25, (8), Schmid, M. W.. (2001). Preventing intravenous catheter-associated infections: an update. Infection Control Today.