GUIDELINES FOR PREVENTION
OF
INFECTIONS ASSOCIATED
WITH
PERIPHERAL VENOUS CATHETERS
How to use it to reduce the risk
of in...
What do we know about PVCs from
the recent prevalence survey?
• 1 in every 3 patients has a PVC!
• The majority of patient...
One study of Peripheral Vascular
Catheters found the following
•
•
•
•
•
•
•
•

52% Of patients had a PVC
33% Of PVCs were...
Extracts from a study into deaths
following MRSA infections
‘Six days post-operatively the patient
was noted to have pus c...
Researchers reported that blood stream
infections (BSIs) caused by PVCs were
statistically more likely to be caused by
Sta...
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 con...
Prevention of
PVC-BSI
Insertion

Maintenance

Removal
The date of cannula removal
must be documented in the medical/nursing
notes.

If a peripheral venous cannula
is not being ...
Peripheral Vascular Catheter Care Bundle
Don’t put them in; Get them out; Look after them properly

The Bundle
1.Checking ...
Peripheral Vascular Catheter (PVC) Care Bundle – Standard Operating Procedure
Statement

PVCs cause phlebitis and insertio...
Ward:

Name of person performing the bundle

Date
Observation
number

The PVC is still in
use;

Absence of
inflammation an...
Summary Table of PVC Bundle Findings

NO.

Comment (if required)

Total number of PVCs in situ at start of PVC Bundle
Tota...
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]
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Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]

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Infection Control Guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.

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Infection control guidelines for Prevention of Peripheral Venous Catheter (PVC) Associated Infections[compatibility mode]

  1. 1. GUIDELINES FOR PREVENTION OF 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, MOH Infection Control CBAHI Surveyor Infection Prevention Control Director, KKH
  2. 2. 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 medical wards • 11% of all HAIs identified were skin and soft tissue infections (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
  3. 3. 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
  4. 4. Extracts from a study into deaths following MRSA infections ‘Six days post-operatively the patient was noted to have pus coming from a cannula site.’ Case study 6 ‘After 8 days the PVC inserted on admission showed signs of infection with a purulent discharge.’ Case study 4 ‘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
  5. 5. Researchers reported that blood stream infections (BSIs) caused by PVCs were statistically more likely to be caused by Staph. aureus than BSIs from central vascular catheters 53% of PVC – BSIs were S. aureus 33% of CVC – BSIs were S. aureus P = 0.01 Staph aureus bacteraemia includes MRSA. Pujol et al JHI 2010
  6. 6. These are Staphylococci sitting on a skin scale that infect PVCs
  7. 7. The blood should be sterile – free from microbes
  8. 8. Infections start locally at the catheter insertion site,, but then…
  9. 9. If the catheter is not removed and the infection is not treated effectively, the organisms can infect the blood
  10. 10. Once the organisms are in the blood a Staph aureus bacteraemia (SAB) has occurred
  11. 11. The best way to prevent microbes from getting into the blood is….
  12. 12. 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.
  13. 13. Prevention of PVC-BSI Insertion Maintenance Removal
  14. 14. The date of cannula removal must be documented in the medical/nursing notes. If a peripheral venous cannula is not being used/required for access, it should be removed.
  15. 15. Peripheral Vascular Catheter Care Bundle Don’t put them in; Get them out; Look after them properly The Bundle 1.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.
  16. 16. Peripheral Vascular Catheter (PVC) Care Bundle – Standard Operating Procedure Statement PVCs 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 to optimise procedures and reduce the risk to patients. Objectives 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 Requiremen Before the PVC Bundle Procedure can be Considered ts Signed 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 Procedure Small clean trolley containing: Alcohol hand gel; Cotton wool balls; Orange or Yellow waste bag; Small sharps container Personal Protective Equipment (PPE): Disposable Gloves – non-sterile; disposable plastic apron Procedure Perform hand hygiene..١ 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 hygiene 7.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.
  17. 17. Ward: Name of person performing the bundle Date Observation number The PVC is still in use; Absence of inflammation and or extra-vasation The PVC dressing is intact Yes Continue bundle Yes Continue bundle Yes No Sample Remove catheter No Remove catheter No Yes Continue bundle Remove catheter Continue bundle 1 No Yes Continue bundle Yes Continue bundle Remove catheter No Remove catheter No Remove catheter The PVC has been inserted for <72 hrs. Yes No Yes No Continue bundle Request removal Continue bundle Remove catheter Hand Hygiene before & after all PVC procedures Yes Continue bundle No Request removal Yes Continue bundle No What was done PVC left in situ PVC Removed PVC left in situ Request removal PVC Removed Yes 2 No Continue bundle Remove catheter Yes No Continue bundle Remove catheter Yes No Continue bundle Yes Continue bundle Yes Continue bundle Remove catheter No Remove catheter No Request removal PVC left in situ PVC Removed Yes Continue bundle Yes Continue bundle Yes Continue bundle Yes Continue bundle Yes Continu e bundle No 3 Remove catheter No Remove catheter No Remove catheter No Remove catheter No Request removal PVC left in situ PVC Removed 4 Yes Continue bundle Yes Continue bundle Yes Continue bundle No Remove catheter No Remove catheter No Remove catheter Yes Continue bundle Yes Continue bundle PVC left in situ No Remove catheter No Request removal PVC Removed
  18. 18. Summary Table of PVC Bundle Findings NO. Comment (if required) 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* All 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 Tick if achieved

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