INTRAVENOUS THERAPY INTRAVENOUS THERAPY

INFECTION CONTROL AND INFECTION CONTROL AND ANTT ANTT

INTRAVENOUS THERAPYINTRAVENOUS THERAPY

IV Devices are indispensableIV Devices are indispensable Over 60% of patients receive Over 60% of patients receive

therapy via an IV devicetherapy via an IV device IV Devices are used to administer IV Devices are used to administer

fluids, blood products, medication fluids, blood products, medication and nutritional support. Also used and nutritional support. Also used to monitor critically ill patients and to monitor critically ill patients and to obtain blood specimensto obtain blood specimens

What are the infection risks What are the infection risks associated with IV devices?associated with IV devices? Any breach in integrity of the skin allows access Any breach in integrity of the skin allows access

of pathogensof pathogens Poor site decontamination prior to line insertionPoor site decontamination prior to line insertion Duration of insertion processDuration of insertion process Repeated catheterisationRepeated catheterisation Experience of personnel inserting deviceExperience of personnel inserting device Duration of IV deviceDuration of IV device Type of dressingType of dressing Poor hygiene during line handlingPoor hygiene during line handling Hub cap contaminationHub cap contamination Age and medical condition (ITU etc)Age and medical condition (ITU etc)

What type of infections do IV What type of infections do IV catheters cause?catheters cause?

Infection at the Infection at the insertion site insertion site (phlebitis)(phlebitis)

Associated more with Associated more with peripheral IV peripheral IV catheterscatheters

Can lead to BSICan lead to BSI

Caused by mechanical Caused by mechanical or chemical irritation or chemical irritation of the veinof the vein

Increased risk with Increased risk with poor skin prep, poor poor skin prep, poor insertion technique, insertion technique, and large deviceand large device

Bloodstream infection (BSI)/ Bloodstream infection (BSI)/ Bacteraemia:Bacteraemia:

IV catheters are the source of IV catheters are the source of around 48% of all BSIaround 48% of all BSI

Associated with central Associated with central venous catheters but can be venous catheters but can be caused by peripheral catheterscaused by peripheral catheters

Increased risk with increased Increased risk with increased morbidity morbidity

BSI associated with a case BSI associated with a case fatality rate of 20% (in the fatality rate of 20% (in the critically ill this rises to 35%)critically ill this rises to 35%)

Bacteria introduced by IV Bacteria introduced by IV catheters may lodge into other catheters may lodge into other tissues and cause secondary tissues and cause secondary endocarditis or osteomyelitisendocarditis or osteomyelitis

Common Organisms Common Organisms responsible for IV device- responsible for IV device-

related infection:related infection:

Staphylococcus epidermidis Staphylococcus epidermidis Staphylococcus aureus Staphylococcus aureus EnterococcusEnterococcus

KlebsiellaKlebsiella PseudomonasPseudomonas Escherichia coliEscherichia coli

Candida Candida

How do you reduce the risk How do you reduce the risk of Infection?of Infection?

ANTTANTT Appropriate dressingAppropriate dressing Appropriate line careAppropriate line care Appropriate hand decontaminationAppropriate hand decontamination - decontaminate hands before & after palpating, - decontaminate hands before & after palpating,

inserting, inserting, replacing or dressing any IV device replacing or dressing any IV device (HICPAC 1996: (HICPAC 1996: CATEGORY 1A)CATEGORY 1A)

- - five moments for hand hygienefive moments for hand hygiene

Your 5 moments for hand hygiene at the point of care*

*Adapted from the WHO Alliance for Patient Safety 2006

Aseptic Non Touch Technique ANNT

ANTT is two things:

1. A set of clinical guidelines aimed at improving and standardising aseptic practice for common clinical procedures.

2. A method of implementing an aseptic standard which establishes clinical compliance in large staff groups.

NB: ANTT complies with ICNA (Infection Control Nurses Association), RCN (Royal College of Nursing), and EPIC2 and DOH guidance. It is the recommended aseptic technique of EPIC 2.

What is ANTT?

Don’t leave key-parts unprotected and exposed

Key-parts should always be protected

References/further info..References/further info.. ANTT ANTT http://www.antt.co.ukhttp://www.antt.co.uk Saving Lives DOH 2007Saving Lives DOH 2007 ORH intranet (Local IC policies) ORH intranet (Local IC policies)

http://orhnet.orh.nhs.uk/infectioncontrol/http://orhnet.orh.nhs.uk/infectioncontrol/ EPIC2 Guidelines EPIC2 Guidelines

http://www.epic.tvu.ac.uk/PDF%20Files/epic2/ehttp://www.epic.tvu.ac.uk/PDF%20Files/epic2/epic2-final.pdfpic2-final.pdf

Health Protection Agency website Health Protection Agency website http://www.hpa.org.uk/http://www.hpa.org.uk/

Department of Health website Department of Health website http://www.dh.gov.uk/Home/fs/enhttp://www.dh.gov.uk/Home/fs/en