Infection Control & Microbiology in IV Therapy An outline A glimpse of intravenous catheter-associated infections Review of cycle of infection Sources of organisms

nisms in catheter-associated infections Sources of infection Recommendations for placement of intravascular catheters in adults & children

A glimpse.. The use of intravascular catheters put patients at risk for local & systemic infectious complications including local site infection, CRBSI, septic thrombophlebitis, endocarditis, & other metastatic infections Approximately 80,000 CVC-associated BSIs occur in ICUs each year in USA Intravascular related BSI increases mortality by 35% Attributable cost of caring patients with vascular related infections ranges 296M$ to 2B$ Types of organisms that commonly cause healthcare associated BSIs Coagulase negative staphylococcus (CoNS) Staphylococcus aureus Enterococci Candida

Pathogenesis Most infections result from migration of skin organisms at the insertion site into the cutaneous catheter tract Other important pathogenic determinants of catheter-related infection are: Material of which the device is made Intrinsic virulence factors of the infecting microorganisms

Recommendations for Placement of Intravascular Catheters in Adults & Children Educate HCWs regarding the indications for intravascular catheter use & appropriate infection control measures to prevent infections Assess knowledge & adherence to guidelines periodically for all persons who insert & manage intravascular catheters Ensure appropriate nursing staff levels in ICUs Monitor catheter sites visually or by palpation Encourage patients to report any changes in catheter site or any discomfort Document date & time of insertion, dressing changes & removal Observe proper hand hygiene Maintain aseptic technique for the insertion & care of IV catheters Wear clean or sterile gloves when inserting IV catheter as well as changing the dressing Do not routinely use arterial or venous cutdowm procedures Disinfect clean skin Allow antiseptic to remain on site & air dry before insertion Use either sterile gauze or transparent semipermeable dressing to cover site Replace damp, loosened, visibly soiled dressing Change dressing weekly Do not submerge the catheter under water Select the catheter, insertion technique & site with the lowest risk of infection Promptly remove any IV catheter that is no longer essential or indicated Do not routinely replace central venous or arterial catheter Replace peripheral venous catheter @ least every 72-96 h

When adherence to aseptic technique cannot be ensured, replace all catheters ASAP, no longer than 48h after insertion Replace any short-term CVC if purulence is observed Replace administration sets no more frequently than 72h interval Replace tubing used to administer blood, blood products, or lipid emulsions within 24 h of initiating infusion Complete infusion of lipid-containing emulsions w/in 24h of hanging Complete infusion of blood & other blood products w/in 4 h of hanging Clean injection ports with 70% alcohol before access Cap all stopcocks when not in use Do not use any container of parenteral fluid that has visible turbidity, leaks, cracks, or particulate matter or expired Use single-dose vials for parenteral additives or medications when possible Refrigerate multidose vials if they are opened if recommended by manufacturer Cleanse the access diaphragm of multidose vials w/ 70% alcohol before inserting a device into the vial Use a sterile device to access a multidose vial & avoid contamination of the device before penetrating the access diaphragm