A care approach to infection control

By John Connole
Sunday, 26 August, 2012

Catheter-related blood stream infections (CRBSIS) and life-threatening hospital acquired infections (HAIS) present a patient well-being challenge for healthcare professionals and an economic burden for healthcare facilities across the world, yet with the right strategies they are also the most preventable. The Australian Hospital and Healthcare Bulletin spoke with leading UK IV nurse consultant, Andrew Jackson, on his recent education tour of Australia, sponsored by 3M.

What changes have you seen in the area of IV therapy over the past 20 years?

IV therapy used to be taken for granted. In the UK, it was traditionally based around medicine and seen purely from a functional perspective rather than from a patient care perspective. Around 15 to 20 years ago nurses started to take an increasing interest in IV therapy and this interest sparked changes in practice. From this the concept of appropriate vascular access device care and management was born.

Around this time we started to see more use of peripheral IV devices such as catheters and cannulas. This was soon followed by technology changes which are still in use today such as ultrasound guided placement.

In the UK the biggest change has been the introduction of evidenced-based practice guidelines, sponsored by the Department of Health: Epic 2. These guidelines were developed by a nurse-led team and fed into a Department of Health sponsored program called ‘Saving Lives’ which adopted a ‘bundle’ approach to care: a set of interventions used collaboratively to improve patient care.

The Saving Lives program was ground breaking from an IV perspective as it encompassed not only central line insertion but also central line care, recognising very early on that it’s not just about putting devices in correctly, it’s fundamentally about caring for the life of the line.

The program also looked beyond central venous access devices and acknowledged the importance of peripheral cannula, which followed an identical approach, setting out guidelines for both cannula insertion and cannula device care.

As the Saving Lives program was sponsored by the Department of Health it meant that every hospital in England was expected to implement the program, audit results and provide feedback to their governing bodies and hospital executive teams.

In recent years there has been greater emphasis on product innovation; we have seen the healthcare industry working in partnership with product companies to improve product development and deliver products that help prevent infection, premature vascular access failure and provide appropriate securement.

How has the issue of CRBSIs and HAIs been addressed in the UK?

Implementation of national guidelines, and a ‘bundle’ care approach to IV management has been key to managing CRBSIs and HAIs in the UK. The ‘Saving Lives’ national guidelines are led by and predominately implemented by nurses focused on vascular access and IV care.

What this means for patients is, they can expect an identical vascular access procedure and standard of care in any hospital in England.

Aside from resuscitation guidelines, there are very few national guidelines in the UK where a patient can expect the same methodical approach to a procedure and ongoing care.

What can Australian healthcare professionals learn from the UK experience?

There are real and tangible benefits for both patients and healthcare organisations in taking a national and bundle care approach to IV therapy and infection control.

To reduce CRBSIs and HAIs it is crucial to recognise that central venous care and peripheral IV care are equally important. We have experienced positive patient outcomes from looking beyond central venous devices to include peripheral IV care – the bar has been raised for all vascular access devices.

What are the key considerations for best practice IV site management?/ What are the key considerations for infection control in IV therapy?

It is imperative that IV site management be addressed at both an individual patient level and at a whole of organisation level.

Vascular access nurses are very good at the ‘nursing process’. That is, assessment, planning, implementation and evaluation. With this approach and philosophy applied to vascular access, all the essential elements of best practice IV site management are covered.

However, without any clear measurement or overview of how many IV infections and problems an organisation is experiencing, it is difficult to address IV infection control appropriately and at best practice levels.

One way of addressing infection measurement issues is through the implementation of a vascular access team that is involved in all forms of vascular access, including peripheral catheter insertion, and can provide broad insights into patient problems such as phlebitis and dislodgement. A team approach is one way to achieve best practice infection control in IV therapy.

Education and an ‘ongoing care’ approach is also imperative to best practice IV site management and infection control. In the UK we have implemented a central line surveillance program, a preventative program called ‘Shoe Leather Surveillance’. It involves daily ‘hands on’ patient monitoring of IV dressings and checks for indications of infection. It is hard work but the ‘life time of catheter approach’ to IV site management is one of the key contributors to our low infection rate.

How have IV securement dressings changed to enable improved infection control?

What’s interesting about the IV dressing is that it has evolved to become more than just a dressing. In years past, IV dressings operated simply as a barrier to bacteria, to help prevent Infections. Today, IV dressings are also designed to help secure and stabilise vascular access devices and to preserve the integrity of the vulnerable vascular access area underneath the dressing.

We are also seeing increased use of medicated, chlorhexidine gluconate (CHG) impregnated dressings to improve infection control at the point where the vascular device enters the skin.

Healthcare professionals are constantly told that good catheter securement is key to managing infection? What is your take on this?

Reducing the bacteria load prior to device insertion is critical to ensuring optimum skin aseptic is achieved. However, it is equally important to ensure that the skin aseptic is maintained. Good catheter securement and a need for repeated re-starts due to device dislodgement. Good securement also helps prevent the individual and organisation costs associated with infection management.

My advicelook for IV dressings that combine advanced securement, transparent panels for IV line visibility and also consider the benefits of incorporating medicated site care.

Where to now for IV therapy and infection prevention?

To further enhance the progression of IV therapy and infection prevention by expanding the bundle care approach to include education, product and surveillance.

Current bundle care guidelines are very clinical, directional and focused on infection prevention, but we need to take them beyond infection prevention to encompass dislodgement, occlusion, phlebitis and infiltration.

There is also a need to standardise hospital education, so that each facility adopts similar teaching practices. Mentoring will also play an important role in driving infection prevention. When I educate nurses in IV therapy I highlight the importance of choosing a mentor who is enthusiastic in IV therapy.

As a final point, I believe we need to stop taking IV therapy for granted – it is such an important part of patient care. If it wasn’t for simple vascular access devices and associated equipment there would be no blood transfusions, chemotherapy or antibiotic treatment. We need to acknowledge that central to patient care is the humble vascular access device.

Andrew Jackson

Andrew Jackson presenting at the IV leadership summit 2011 in St Paul, Minnesota.

Andrew’s work is internationally recognised, Andrew was highly commended in the Nursing Standard 2001 awards and he was winner of the surgi cal category of the 2001 Trent nurse of the year awards.

In 2001, six years following the start of his IV career Andrew was appointed as the first IV Nurse Consultant in the UK.

Working in a 600 bedded district general hospital, Andrew splits his time between clinical, educational, research and leadership activities. Andrew’s particular IV therapy and care interests focus on ultrasound guided vascular access, staff education, policy integration, innovation review and preventing premature device failure.

Achievements include, the introduction of a hospital-wide vascular access team and the development of a peripheral IV site monitoring tool, ‘The VIP score’.

In his spare time Andrew also runs an IV news website at www.ivteam.com and an online intravenous journal at www.ivjournal.com

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