1. Peripheral Vascular Cannulas so far ……..
Meleri Jenkins
Infection Prevention and Control Nurse
Hywel Dda Health Board

2. Point Prevalence Study
Carmarthen Division
No CAUTI
3 PVC infections

3. Peripheral Vascular Catheters
‘The greatest risk factor for
developing a bacteraemia is an
indwelling intravascular catheter’
Duerden 2007
‘At any one time 61% of hospital patients will have a peripheral intravenous catheter’
2006 HCAI Prevalence Survey

6. Routes of access of causative microorganisms
Intraluminal migration
Extraluminal migration
Contaminated catheter hub
- Patients skin flora
- HCP hands
Skin organisms
- Patients skin flora
- HCP hands
- Contaminated disinfectant
60%
12%
<1%
Contaminated
infusates
Contaminated infusate
- Extrinsic (Fluid, Medication)
- Intrinsic (Manufacturer)
Insertion site colonisation
Unknown – Local infection and heamatogenous seeding as well as 1,2,3.
So how do the microorganisms gain access to the catheter to initiate infection? By gaining access to the extraluminal or intraluminal surface of the device where they become incorporated into a biofilm that allows sustained infection and haematogenous dissemination .
Contamination from fluid infused/administered through the device is rare and is the most likely cause of epidemic BSIs but catheter related infections are the cause of most endemic BSIs.
Microorganisms gain access by one of the three following mechanisms 1) the microorganisms may be impacted during catheter insertion, invading the percutaneous tract. 2) Microorganisms contaminate the catheter hub (and lumen) 3) organisms are carried haematogenously to the implanted IVD from remote sources of infection, eg pneumonia.
Unknown = 28%
Haematogenous seeding from distant infection
Impaction during insertion
Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med 2004;30:62-7.

7. Insertion poor skin disinfection no documentation no date of insertion
no accountablity

8. Skin Disinfection Choices 2% chlorhexidine in 70% Isopropyl Alcohol
Povidone iodine solution

9. Skin Disinfection DOH Guidelines – UK, February 2007 Epic2:
National Evidence-Based Guidelines for Preventing Healthcare-Associated
Infections in NHS Hospitals in England

10. PLAN Introduce Chloraprep Sepp (2%Chlorhexidine in 70%Alcohol)
Insertion Bundle Sticker
Pilot at 2 Ward areas in Prince Phillip Hospital – identify ward champion
Ward 1 / SSU
Ward 4

11. ChloraPrep 1.5ml Frepp ChloraPrep 0.67ml Sepp Coverage area:
10 x 13 cm
For procedures such as:
Blood culture collections
Peripheral canulation
AV fistula and ‘portacath’ access
Simple biopsies and minor procedures
ChloraPrep 0.67ml Sepp
Coverage area:
5 x 8 cm
For procedures such as:
Peripheral canulation
Surgical pin site cleansing
Subcutaneous device insertions
Always allow the prepped area to air dry completely before carrying on with any procedure

12. Peripheral Vascular Cannula - Insertion Bundle Sticker

13. Saving Lives – HII, Peripheral Vascular Catheters

15. Visual Infusion Phlebitis Score

16. Study Audit after 4 weeks Number of PVC’S on ward Length insitu
Vascular Infusion Phlebitis Score
Use of Insertion Bundle Sticker
Cost of introducing Chloraprep

17. Act Review/Amend use of sticker Review use of Daily Data Sheet
Look at introducing a PVC Maintenance Bundle into the Nursing Careplan
Rollout - Prince Phillip Hospital early 2011, follow through to the rest of
the Health Board