CRBSI: GUIDELINES ON REDUCING RISK AT ALL ACCESS POINTS HELEN HARKER

Transcription

1 CRBSI: GUIDELINES ON REDUCING RISK AT ALL ACCESS POINTS HELEN HARKER SENIOR NURSE INTRAVENOUS ACCESS ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY TEACHING HOSPITALS

2 ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY TEACHING HOSPITALS Catchment population of more than two million people in Merseyside, Cheshire, North Wales, the Isle of Man and beyond We provide a comprehensive range of specialist services to 750,000 people each year Awarded title, Centre of Excellence for Infection Control and Prevention

3 Reliable vascular access is a fundamental part of healthcare delivery today. (Maki et al, 2006)

4 Bacteraemia (blood stream infection) arising from the insertion and management of VADs is one of the most hazardous complications in healthcare today. (Pratt et al, 2014)

5 Microorganisms at the point where the device enters the body (exit site) or at the infusion entry point (hub/needle free device) are the most common causes of these infections. (Pratt et al, 2014)

6 CRBSI A blood stream infection with a catheter determined as the originating source. Diagnosis requires thorough laboratory investigation. (Naomi et al, 2011)

7 GUIDANCE EPIC 3:National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England CDC: Guidelines for the Prevention of Intravascular Catheter-Related Infections National Institute for Health and Care Excellence Department of Health Royal College of Nursing British Committee for Standards in Haematology European Society for Clinical Nutrition and Metabolism Evidence within the Literature

8 PREVENTION Education, training and peer review Device selection Equipment, products, technology VAD associated complications Surveillance Collaborative MDT working

9 EDUCATION AND POLICY ADHERENCE Existence of policies and guidelines does not necessarily equate adherence (Higgins & Evans, 2008) Fundamental for healthcare workers involved in the insertion, care and management of VADs (Naomi et al, 2011 & Loveday et al, 2014) Incidences of VAD infection increases when inexperienced health professionals provide care (Eggiman et al, 2000) VAD infections decrease following implementation of education programmes (Coppersmith et al,2004; Sherertz et al, 2000; Xiao et al, 2007)

10

11

12 DETERMINANTS OF APPROPRIATE DEVICE SELECTION Potential treatments Duration of therapy Venous/site availability Anatomy, diagnosis and co-morbidities Device material Risk assessment

13 EQUIPMENT, PRODUCTS AND TECHNOLOGY

14

15

16

17

18

19 INFLUENTIAL VAD ASSOCIATED COMPLICATIONS Catheter manipulation / rewire Thrombus Occlusion Fracture Fibrin

20 SURVEILLANCE Distinguishes area of excellence Detects areas requiring additional resources Demonstrates outcomes Determines cost effectiveness Powerful instrument

21 MULTIDISCIPLINARY COLLABORATION Infection prevention and control team Microbiology services Executive group Radiology department Community IV therapy teams Procurement staff Clinical Skills Service Tissue viability experts

22 CONCLUSION Standardisation of the most appropriate training, practice, interventions and technology can potentially prevent CRBSI and reduce costs

23 FUTURE ASPIRATIONS AND OBJECTIVES Regularisation of services Standardisation of practices National commitment

24 REFERENCES 1 COOPERSMITH, C M, ZACK, J E, WARD, M R, SONA, C S, SCHALLOM, M E, EVERETT, S J, HUEY, W Y, GARRISON, T M, MCDONALD, J, BUCHMAN, T G, BOYLE, W A, FRASER, V J & POLISH, L B (2004). THE IMPACT OF BEDSIDE BEHAVIOUR ON CATHETR-RELATED BACTERAEMIA IN THE INTENSIVE CARE UNIT. ARCHIVES OF SURGERY 139: EGGIMANN P, HARBARTH S, CONSTANTIN M, TOUVENEAU S, CHEVROLET J, PITTET D. IMPACT OF A PREVENTION STRATEGY TARGETED AT VASCULAR- ACCESS CARE ON INCIDENCE OF INFECTIONS ACQUIRED IN INTENSIVE CARE. LANCET 2000;355: H.P. LOVEDAY, J.A. WILSON, R.J. PRATT, M. GOLSORKHI, A. TINGLE, A. BAK, J. BROWNE, J. PRIETO, M. WILCOX (2014):EPIC 3 NATIONAL EVIDENCE-BASES GUIDELINES FOR PREVENTING HEALTH-CARE ASSOCIATED INFECTIONS IN NHS HOSPITAL IN ENGLAND. JOURNAL OF HOSPITAL INFECTION 86S1 (2014) S1 S70. AVAILABLE: [2014, JANUARY] MAKI, D G, KLUGER, D M, & CRNICH, C J (2006). THE RISK OF BLOODSTREAM INFECTION IN ADULTS WITH DIFFERENT INTRAVASCULAR DEVICE: A SYSTEMATIC REVIEW OF 200 PUBLISHED PROSPECTIVE STUDIES. MAYO CLINIC PROCEEDINGS 81 (9): NAOMI P. O'GRADY, M.D., MARY ALEXANDER, R.N., LILLIAN A. BURNS, M.T., M.P.H., C.I.C., E. PATCHEN DELLINGER, M.D., JEFFERY GARLAND, M.D., S.M., STEPHEN O. HEARD, M.D., PAMELA A. LIPSETT, M.D., HENRY MASUR, M.D., LEONARD A. MERMEL, D.O., SC.M., MICHELE L. PEARSON, M.D., ISSAM I. RAAD, M.D., ADRIENNE RANDOLPH, M.D., M.SC., MARK E. RUPP, M.D., SANJAY SAINT, M.D., M.P.H. AND THE HEALTHCARE INFECTION CONTROL PRACTICES ADVISORY COMMITTEE (HICPAC). (2011) CDC GUIDELINES FOR THE PREVENTION OF INTRAVASCULAR CATHETER-RELATED INFECTIONS. DEPARTMENT OF HEALTH AND HUMAN SCIENCES.

25 REFERENCES 2 SHERERTZ, R J, ELY, E W, WESTBROOK, D M, GLEDHILL, K S, STREED, S A, KIGER, B, FLYNN, L HAYES, S, STRONG, S, CRUZ, BOWTON, D L, HULGAN, T & HAPONIK, E F (2000). EDUCATION OF PHYSICIANS-IN-TRAINING CAN DECREASE THE RISK FOR VASCULAR CATHETER INFECTION. ANNALS OF INTERNAL MEDICINE. 132 (8): XIAO, Y, SEAGULL, F J, BOCHICCHIO, G V, GUZZO, J L, DUTTON, R P, SISLEY, A, JOSHI, M, STANDIFORD, H C, HEBDEN, J N, MACKENZIE, C F & SCALEA, T M (2007). VIDEO-BASED TRAINING INCREASES STERILE-TECHNIQUE COMPLIANCE DURING CENTRAL VENOUS CATHETER INSERTION. CRITICAL CARE MEDICINE 35 (5) :

26