1. IV Medicine Administration: Infection Control September 2009

2. February 20092 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.

3. February 20093 Chain of Infection – Administration of IV Therapy Reservoir Infectious Agent/Organism Means of Exit Route of Transmission Means of Entry Susceptible Host

4. February 20094 Staphylococcus epidermidis Staphylococcus aureus Enterococcus spp. Klebsiella Pseudomonas E. Coli Serratia Candida Infectious Micro-organisms associated with IV therapy

5. February 20095 Reservoirs Patients Skin – resident microflora Environment Equipment IV Solutions & drugs HCW Hands -Transient microflora

6. February 20096 Means of Exit Secretions such as bodily fluids e.g. blood Skin such as skin scales

7. February 20097 Route of Transmission Direct contact - on healthcare workers hands Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates Puncture of skin (inoculation / blood borne)

8. February 20098 Means of entry Contaminated on insertion Contaminated fluid Patient’s skin microflora Local infection Operator’s microflora Haematogenous spread Migration down catheter inside and out

9. February 20099 Susceptible Host Extremes of age Surgery Extended length of stay in hospital Compromised immune system Chronic disease Antibiotics Vascular access device in-situ

10. February 200910 Standard Precautions The minimal level of infection control precautions that apply in all situations.

11. February 200911 Isolation There are 9 elements to Standard Precautions Hand Hygiene PPE Clinical waste Linen Spillages Occupational Exposure Environment Patient Care Equipment

12. February 200912 Preparation Clean Work Surface Hand Decontamination Reconstitution Patient Preparation- explanation/skin Venous access preparation Remember if you are interrupted you need to decontaminate your hands again

13. February 200913 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

14. February 200914 Detection of Infection Infection can present in a number of ways: Local Site Infection Microbial Phlebitis Systemic Infection

15. February 200915 Inspection At set Intervals, inspect for signs of local infection & phlebitis: 1.Tenderness 2.Erythema 3.Swelling 4.Purulent Discharge 5.Palpable Venous cord

16. February 200916 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 and causative organisms isolated

17. February 200917

18. February 200918 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

19. February 200919 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.

20. February 200920 Treatment Stop the infusion - inform medical staff Send blood cultures & swab from site Monitor vital signs Remove the line - send tip to microbiology for culture

21. February 200921 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

22. February 200922 Documentation Document all IV sites 12 hourly (once per shift) Nursing Notes Patient Care Plans Documentation is evidence that assessment has been carried out

23. February 200923 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