GUIDELINES FOR PREVENTIONOF

INFECTIONS ASSOCIATED WITH

PERIPHERAL VENOUS CATHETERS How to use it to reduce the risk of insertion site sepsis and blood stream infections in your ward

Dr. Nahla Abdel Kader, MD. PhD.Infection Control Consultant, MOHInfection Control CBAHI Surveyor

Infection Prevention Control Director,KKH

What do we know about PVCs from the recent prevalence survey?

• 1 in every 3 patients has a PVC!

• The majority of patients with PVCs are in the medicalwards

• 11% of all HAIs identified were skin and soft tissueinfections (many related to PVCs)

• So big a problem was identified that skin and soft tissue infections related to PVCs are considered a ‘Priority Area’.

Source: Scottish National Prevalence Survey 2010

One study of Peripheral Vascular Catheters found the following

• 52% Of patients had a PVC • 33% Of PVCs were incorrectly dressed• 52% Of PVCs were incorrectly positioned• 46% Of PVCs were unused for 24 hours• 23% Of PVCs had never been used• 23% Of PVCs had no documented purpose• 12% Of PVCs had visible phlebitis• 6% Of PVCs had infiltration

Thomas et al JHI 2010

Extracts from a study into deaths following MRSA infections

‘After 8 days the PVC inserted on admission showed signs of infection with a purulent discharge.’ Case study 4

‘Six days post-operatively the patientwas noted to have pus coming from a cannula site.’ Case study 6

‘For almost half of the cases reviewed,The source of the MRSA infection was an invasive device, particularly PVC and CVC.’

http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=107

Researchers reported that blood stream infections (BSIs) caused by PVCs were

statistically more likely to be caused byStaph. aureus than BSIs from central vascular

catheters

53% of PVC – BSIs were S. aureus33% of CVC – BSIs were S. aureus

P = 0.01

Pujol et al JHI 2010

Staph aureus bacteraemia includes MRSA.

These are Staphylococci sitting on a skin scale that infect PVCs

The blood should be sterile – free from microbes

Infections start locally at the catheter insertion

site,, but then…

If the catheter is not removed and the infection

is not treated effectively, the organisms can infect the

blood

Once the organisms are in the blood a Staph aureus bacteraemia (SAB) has

occurred

The best way to prevent microbes from getting

into the blood is….

Peripheral intravenous cannulae present a high risk for HCAIs.

The need for an intravenous cannula requires careful consideration.

It should not be a routine procedure when admitting/ assessing patients.

Due care should be taken when handling sharps/needles to avoid sharps/needle stick injury.

Prevention of PVC-BSI

MaintenanceInsertion Removal

The date of cannula removalmust be documented in the medical/nursing

notes.

If a peripheral venous cannulais not being used/required for access, it

should be removed.

The BundleThe Bundle1.Checking the PVC in situ is still required.

2. Removing PVC where there is extravasation or inflammation.

3. Checking PVC dressings are intact.

4. Considering removal of PVC in situ longer than 72 hours.

5. Performing hand hygiene before and after all PVC procedures.

Peripheral Vascular Catheter Care BundleDon’t put them in; Get them out; Look after them properly

Peripheral Vascular Catheter (PVC) Care Bundle – Standard Operating ProcedurePVCs cause phlebitis and insertion site sepsis; PVCs are the third leading cause of device-related blood stream infections. Complications arise directly from their use and in particular if the care is sub optimal. We have a duty to our patients to optimise PVC care and to ensure that our PVC care does not cause the patients harm. Monitoring our PVC care will assist us tooptimise procedures and reduce the risk to patients.

Statement

Objectives:1.To optimise Peripheral Vascular Catheter (PVC) care in OUR ward and reduce as far as possible any infectious complications.2.To be able to demonstrate quality PVC care in OUR ward

Objectives

Before the PVC Bundle Procedure can be ConsideredSigned commitment from the clinical team: consultants; junior doctors, ward manager and nurse team to optimising PVC care.Signed agreement from all consultants that named individuals on a weekly/named basis will undertake a PVC bundle, including agreement from the clinical team for the actions within the bundle.Named individuals competent in performing the bundle as written.Prior to starting the PVC Bundle ProcedureSmall clean trolley containing: Alcohol hand gel; Cotton wool balls;

Orange or Yellow waste bag; Small sharps containerPersonal Protective Equipment (PPE): Disposable Gloves – non-sterile; disposable plastic apron

Requirements

.١Perform hand hygiene.2.Collect a bundle sheet and complete the top boxes: name, location, etc.3.Proceed to the first patient.4.Introduce yourself to the patient and explain that you are checking all catheters to see if any need removed.5.If it is not obvious ask ‘Do you have any of these needles, catheters or cannulae?’ If the answer is ‘no’ thank the patient, move on to the next patient and go back to step 4. If the answer is ‘yes’ proceed to number 6. 6.If it is obvious they do have a catheter, or they have said they do, perform hand hygiene7.Maintaining the patient’s privacy, ask to see the catheter insertion site – complete the bundle questions. Ask ‘buddy nurse’* to confirm hand hygiene procedures and alcohol hub procedures have been optimal. NB Extra-vasiation may still be detected even if there is a sterile gauze dressing over the insertion site, however, NEVER, removes a dressing just to view an insertion site. If the dressing does not facilitate observation of the insertion site then score on extra-vasiation alone. 8.If deemed necessary, remove the catheter aseptically [wearing appropriate PPE]. If you are unsure as to whether to remove the catheter – confirm with a member of the medical team the appropriateness of removing the catheter remaining in situ.9.Perform hand hygiene.

Procedure

Name of person performing the bundleWard:

Date

What was done

Hand Hygiene before & after all PVC procedures

The PVC has been inserted for

<72 hrs.

The PVC dressing is intact

Absence of inflammation and or

extra-vasation

The PVC is still in use;

Observation number

PVC left in situ

Sample

PVC Removed

PVC left in situ1

PVC Removed

PVC left in situ2

PVC Removed

PVC left in situ3

PVC Removed

PVC left in situ4

PVC Removed

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Request removal

No

Continue bundle

Yes

Request removal

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Request removal

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Request removal

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Request removal

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Remove catheter

No

Continue bundle

Yes

Request removal

No

Comment (if required)NO.Summary Table of PVC Bundle Findings

Total number of PVCs in situ at start of PVC Bundle

Total number of PVCs removed because they were not being used or were no longer required.

Total number of PVCs removed because of extravasation or insertion site inflammation

Total number of PVCs removed because the dressing was not intact or was inappropriate

Total number of PVCs in situ longer than 72 hours.

Total number of PVCs where hand hygiene has been performed before and after all PVC procedures*

Tick if achievedAll or None Table – Was PVC Care Today Optimal

100% of PVCs in situ are required

0% (Zero) PVCs had extravasation or insertion site inflammation

100% of PVCs had appropriate and intact dressings

0% (Zero) PVCs removed as a consequence of the bundle round

0% (Zero) of PVCs were in situ >72 hours.

100% of PVCs were visible and well positioned

If all the above were achieved the PVC care was optimal

Signature of person completing the PVC bundle:Date bundle completed