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Prevention of Intravascular Device-Associated Infections

Prevention of Intravascular Device-Associated Infections. Learning objectives. Describe the relevance and impact of intravascular Device-Associated infections. Identify infection sources and routes of transmission for intravascular infections.

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Prevention of Intravascular Device-Associated Infections

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  1. Prevention of IntravascularDevice-Associated Infections

  2. Learning objectives • Describe the relevance and impact of intravascular Device-Associated infections. • Identify infection sources and routes of transmission for intravascular infections. • Outline the main recommendations to prevent those infections.

  3. Time involved • 30 minutes

  4. Introduction • Intravenous (IV) infusions among the commonest invasive procedures (peripheral or central) • IV central catheters are the main source of bloodstream infection (CLABSI) • Infections associated: • Cellulitis, abscess, thrombophlebitis, bacteraemia, endocarditis • Principles to prevent infections similar for central and peripheral catheters

  5. Key points • Strict asepsis for insertion and maintenance of catheters • Insertion site dry and protected with a sterile dressing • No touch technique • IV line secure without movements • Closed system • Inspection of the insertion site daily • Remove the catheters as soon as possible • No reuse of catheters intended for single use • Healthcare personnel educated and their knowledge assessed • Alternative routes for hydration or parenteral therapy

  6. Sites of possible contamination of intravascular infusions

  7. Sources and Routes of Transmission - 1 • Sources of contamination intrinsic or extrinsic • Most microorganisms from the patient’s skin flora • Contamination of device hub also a source of infection • S. aureus - 60 to 90% of infections

  8. Sources and Routes of Transmission - 2 Flora del paciente Hands of staff Contamination of fluids Skin flora Contamination of insertion site Injections ports Contaminación de las conexiones Seed from distant site

  9. Prevention of Infections - 1

  10. Prevention of Infections - 2

  11. General Comments - 1 • Routine changes of peripheral IV catheters not required • In adults recommendation to change every 72-96 hours to reduce phlebitis • In children should not be replaced routinely • Routine replacement of central catheters not necessary • Central catheters used only when indicated • Non-essential catheters removed • Risk of infection increases with length of catheterisation

  12. General Comments - 2 • Teflon or polyurethane catheters associated with fewer infections • Steel needles same rate of infection as Teflon catheters • Steel needles complicated by infiltration of IV fluids • Well-trained staff to set up and maintain infusions • Masks, caps, and gowns not necessary for insertion of peripheral IV lines • Use of non-sterile barriers will protect the operator if blood exposure likely

  13. Protocol for peripheral infusions - 1 • Place arm on a clean sheet or towel • Hand hygiene (alcohol hand rub or antiseptic soap) • Dry hands on a paper or unused linen towel • Hand hygiene (gloves does not replace it) • Not remove hair (if necessary clip, avoid shaving) • Disinfect skin site, apply for 30 seconds and allow drying • 0.5% chlorhexidine-alcohol, 2% tincture of iodine, 10% alcoholic povidone-iodine, or isopropanol). • Chlorhexidine products should not be used in children younger than 2 months

  14. Protocol for peripheral infusions - 2 • Cannula preferably in an upper limb • Secure sterile dressing • Transparent dressings allow inspection of the site • Secure cannula, label with insertion date • Assess need for catheter every 24 hours • Inspect catheter daily • Avoid cut downs, especially in the leg • Cannulae and sets must be sterile

  15. Additional guidelines for central catheters • Selection of site • Higher infections for jugular and femoral • Maximum barriers • Disinfect skin with 2% chlorhexidine/alcohol • Change transparent dressings once a week or if soiled, loose, or damp, gauze every two days • Replace sets not for blood or lipids no more than 72 hours

  16. Measures that should not be considered as part of a general prevention policy: • Systemic antibiotic prophylaxis • Topical use of antimicrobial ointments • Routine replacement of central venous catheters • Routine use of antibiotic locks for central venous catheters • Routine use of in-line filters

  17. References - 1 • Marschall J, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control HospEpidemiol2008; 29(suppl. 1): S22-S30. http://www.jstor.org/stable/10.1086/591059 • Marchaim D, et al. Epidemiology of bacteraemia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient’s age. Eur J ClinMicrobiol Infect Dis 2008; 27:1045-51. • Standards for infusion therapy. Royal College of Nursing, 2010. http://www.rcn.org.uk/__data/assets/pdf_file/0005/78593/002179.pdf

  18. References - 2 • Marschall J. Catheter-associated bloodstream-infections: Looking outside of the ICU. Am J Infect Control 2008; 36:172.e5-8. • Collignon PJ, et al. Intravascular catheter bloodstream infections: an effective and sustained hospital-wide prevention program for 8 years. Med J Austr2007; 187:551-554. • Guidelines for the Prevention of Intravascular Catheter-Related Prevention of Intravascular Device-Associated Infections Infections, 2002. MMWR 2002; 51:1-26. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

  19. Quiz • IV central catheters are the main source of bloodstream infection . T/F? • The main strategy to prevent CLABSI is • Avoid unnecessary catheters • Good selection of insertion site • Teflon catheters • Change peripheral catheters every 72 hours • Which measure should not be considered to prevent intravascular infections? • Aseptic technique in insertion and maintenance of catheters • Skin antisepsis with 2% chlorhexidine/alcohol • Routine replacement of central venous catheters • Maximum barriers for insertion of central catheters

  20. International Federation of Infection Control • IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe . • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http://theific.org/

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