The amount of infections related to central venous access devices(3)

Catheter-related infections – The statistics

The approximate number of patients admitted to hospital in the UK acquires a bloodstream infection(1)

to treat (could cost significantly more)

£3,000costs at least and results in the

patient spending

in hospital(4)

3x longeracquired in hospital1 infection x3

of patients with a Central Venous Catheter acquire at least one (HCAI) Health Care Acquired Infection(2)

Catheter-related bloodstream infections

(CR-BSI) associated with the insertion and maintenance of CVC are potentially among the

most dangerous complications associated with healthcare(1)

The risks

Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone

There is a legal requirementto ensure infection prevention is a priority(7)

RISKREDUCED

Risk of infection reduceswhen all elements within the clinical process are performed every time and for every patient(5)

RISKINCREASED

Risk of infection increaseswhen one or more elements of a procedure are excluded or not performed(5)

by using the care bundle and adopting care guidelines(6)

Actively REDUCE HCAI’s

It is essential that everyone involved in caring for patients with intravascular catheters is educated about infection prevention.

Recommendation3M can help you to identify your requirements and training needs from staff training to educational programmes. Our team of clinical specialists has first hand experience of the demands of the NHS and can help with trouble shooting and disseminating best practice.

3M Solution

EVIDENCE – Evidence reviewed by Healthcare Infection Control Practices Advisory Committee (HICPAC) consistently demonstrated that the risk of infection declines following the standardisation of aseptic care(8) and increases when the maintenance of intravascular catheters is undertaken by inexperienced healthcare workers.(9)

Education

Selection of catheter and insertion site

EVIDENCE – Multi-lumen catheters may be particularly prone to infection because of increased trauma at the insertion site or increased frequency for CVC manipulation(10)

Selection of catheter site

Selection of catheter

Use the minimumnumber of ports or lumen required for patients therapy

Consideration should be given to catheter site selection, weighing up the risks and benefits of both infectious and mechanical complications(6)

Hand hygiene

WHO recommends that there are 5 crucial moments for hand hygiene.

Recommendation

4 After patient contact

3

Befo

re as

eptic

task

2

After body flu

id

exposure ris

k 5 After contact with patient surroundings

1Before patient contactmoments for

hand hygiene

EVIDENCE – There are extensive studies about hand hygiene especially when to undertake and which product to use.(11,12)

This recommendation is based on WHO Hand Hygiene guidance(13)

Skin preparation

EVIDENCE – CHG Preparation reduces the risk of catheter related infection by 49% compared with preparation using povidone iodine (PI)(1)

30%Catheter hub(15)

Other pathways(15)5%

Skin(15)65%

Vein

Decontaminate skin with a single use application of 2% CHG in 70% isopropylalcohol(5)

Skin flora at the catheter insertion site is a major risk factor for catheter-related blood stream infections (CR-BSIs) and the majority of CR-BSIs originate from the patient’s own skin flora(14)

Protect the insertion site

EVIDENCE – Compliance with maximum sterile barrier precautions significantly minimises catheter contaminations and related infections(17)

*Laboratory testing has proven that the intact film provides a barrier against HIV-1 and HBV whilst the dressing remains intact without leakage.

Local infection

Hub colonisationPatient’s microflora

Patient’s skin flora

Haematogenous spread

Vein

Skin

Line contaminated on insertion

Contaminated infusate

Use maximum sterile barrier precautions

Tegaderm film dressings provide a waterproof and breathable barrier to external contamination including liquids, bacteria and yeast*

3M™ Tegaderm™ CHG I.V. Securement Dressing. CHG gel pad provides continuous antimicrobial action directly at the insertion site to reduce skin colonisation and suppress skin flora regrowth(16)

Catheter site care

DressingsA sterile, transparent, semi permeable dressing to allow observation of insertion site(5)

DocumentationDetails of insertion tobe documented:Date, location, type and catheter lot number and operator(5)

Site inspectionSite to be inspected daily for signs of infection and recorded daily in patient notes(5)

3M solutionDressings containing

2% CHGmay also reduce the incident of catheter site infection(5)

3M™ Tegaderm™ CHG I.V. Securement Dressing combines the powerful antimicrobial effectiveness of CHG with the ease-of-use and transparency of Tegaderm dressing, to further protect the I.V. site, reduce risks associated with CR-BSI and improve outcomes.

Handles for application reduces the risk of touch contamination of the skin side of the dressing, faciliting a non-touch technique and easy and accurate positioning of the dressing. The transparent window permits regular and easy visual monitoring.

EVERYDAY

Catheter management

as soon as no longer required or in line with local guidelinesDocument removal details in patient records

Don’t touch

Remove the catheter

Aseptic Non Touch Technique (ANTT®) Precautions should be taken with any interaction with a CVC(5)

in 70% isopropyl alcohol2% CHG

for lines in frequent use, the use of heparin or antimicrobial locking solutions as designated by local policy

Lumen should be flushed

with 0.9% Sodium Chloride

to decontaminate port or hub(5)

Scrub the hub

References

(1) Pratt RJ et al Journal of Hospital Infection 2007 Feb;65 Suppl 1:S1-64. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.

(2) European acute care hospitals 2011–2012 ECDC SURVEILLANCE REPORT–http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf

(3) Surveillance of hospital acquired bacteraemia in 61 English Hospitals 1997-1999: PHLS (2000)

(4) Plowman R, Graves N, Griffin M et al (1999) The socio-economic burden of hospital acquired infection. London: Public Health Laboratory Service.

(5) Department of Health, High Impact Interventions 2010. Accessed Nov 2013–http://webarchive.nationalarchives.gov.uk/20120118164404/hcai.dh.gov.uk/whatdoido/high-impact-interventions/

(6) O'Grady et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011 Centers for Disease Control and Prevention

(7) DH (2010) The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance.

(8) Warren, D et al. The Effect of an education program on the incidence of a central venous catheter-associated bloodstream infection in a medical ICU. Clinical Investigation in Critical care 2004 5:1612-1618.

(9) Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000; 355: 1864-8.

(10) Hilton E, Haslett TM, Borenstein MT, Tucci V, Isenberg HD, Singer C. Central catheter infections; single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters. Am J Med 1988; 84: 667-672.

(11) Pittet D et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet, 2000, 356:1307–1312.

(12) Sax H et al. ‘My five moments for hand hygiene’: a user–centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection, 2007, 67:9–21.

(13) WHO (2009) Guidelines on Hand Hygiene in Health Care.

(14) Mermel LA. What is the predominant source of intravascular catheter infections? Clinical Infectious Diseases 2011; 52:211-212. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002; 51(RR10);1-26.

(15) E. Bouza, A. Burillo and P. Munoz. 2002 Catheter-related infections: diagnosis and intravascular treatment. Clinical Microbiology and Infection. Volume 8, Issue 5

(16) Bashir MH et al; Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate-prepped skin, American Journal of Infection Control, Volume 40, Issue 4, May 2012, Pages 344-348

(17) Carrer S, Bocchi A, Bortolotti M, Braga N, Gilli G, Candini M, Tartari S. Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site. Minerva Anestesiol 2005; 71: 197-206.

3M and Tegaderm are trademarks of the 3M Company. © 3M 2013.ANTT® Registered Trademark of Association for Safe Aseptic Practice.

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