infection control: iv drug administration. learning outcomes explain the chain of infection and...
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Infection Control:IV Drug Administration
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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.
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Chain of Infection –Administration of IV
Therapy
Reservoir
Infectious Agent/Organism
Means of Exit
Route of Transmission
Means of Entry
Susceptible Host
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• Staphylococcus epidermidis • Staphylococcus aureus• Enterococcus spp. • Klebsiella• Pseudomonas• E. Coli• Serratia• Candida
Infectious Micro-organisms associated with IV therapy
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Reservoirs
• Patients Skin – resident microflora
• Environment
• Equipment
• IV Solutions & drugs
• HCW Hands -Transient microflora
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Means of Exit
• Secretions such as bodily fluids e.g. blood
• Skin such as skin scales
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Route of Transmission
• Direct contact - on healthcare workers hands
• Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates
• Puncture of skin (inoculation / blood borne)
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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
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Susceptible Host
• Extremes of age• Surgery• Extended length of stay in hospital• Compromised immune system• Chronic disease• Antibiotics• Vascular access device in-situ
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Standard Precautions
The minimal level of infection control precautions that apply in
all situations.
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Isolation
There are 9 elements to Standard Precautions
Hand Hygiene
PPE
Clinical waste
Linen
SpillagesOccupational Exposure
Environment
Patient Care Equipment
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Preparation
• Clean Work Surface• Hand
Decontamination • Reconstitution• Patient Preparation-
explanation/skin• Venous access
preparationRemember if you are disturbed you need to
decontaminate your hands again
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AdministrationAdditive/solutionsAlways check:
• Packaging Intact• Expiry date• Particulate Matter• Glass for cracks
Bolus/flushesAlways:
• Clean the port thoroughly
• Where possible use needle free connector
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Detection of Infection
Infection can present in a number of ways:
• Local Site Infection • Microbial Phlebitis• Systemic Infection
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Inspection
At set Intervals, inspect for signs oflocal infection & phlebitis:
1. Tenderness2. Erythema3. Swelling4. Purulent Discharge5. Palpable Venous cord
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Suspected Cannula Infection/Phlebitis
Local-• stop infusion, • swab site if discharge visible• if central or arterial line - send tip to microbiology for culture.• Inform medics
Systemic-• as above,• Vital Signs observations• inform medics.
Treatment dependent on individual, presentation, and causative organisms isolated.
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Phlebitis Scale (Jackson 1998)
IV site appears healthy
One of the following is evident:•Slight pain near IV site
OR•Slight redness near IV site
TWO of the following signs are evident:•Pain at IV site•Erythema•Swelling
ALL of the following signs are evident:•Pain along path of cannula•Erythema•Induration
ALL of the following signs are evident & extensive:•Pain along path of cannula•Erythema & Induration•Palpable Venous Cord
ALL of the following signs are evident & extensive:•Pain along path of cannula•Erythema & Induration•Palpable venous cord & Pyrexia
Early Stage of Phlebitis
RESITE CANNULA
Medium stage of Phlebitis
RESITE CANNULACONSIDER TREATMENT
Advanced stage of phlebitis or the start of thrombophebitis
RESITE CANNULACONSIDER TREATMENT
Advanced stage of Thrombophebitis
INITIATE TREATMENT RESITE CANNULA
Possibly first signs of Phlebitis
OBSERVE CANNULA
No Signs of Phlebitis
OBSERVE CANNULA0
1
22
3
4
45
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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
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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.
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Treatment
• Stop the infusion - inform medical staff
• Send the infusate to microbiology for culture.
• Send blood cultures & swab from site.
• Monitor vital signs.
• Remove the line - send tip to microbiology for culture.
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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
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Documentation
• Document all IV sites daily
• Nursing Notes
• Care Plans
• Daily documentation is evidence that assessment has been carried out
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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
• Patients should be closely monitored for signs of infection
• Good documentation is essential