NURSES DUTIES AND

RESPONSIBILITIES ON
INFECTION PREVENTION
AND SAFETY COMPLIANCE
IN IV THERAPY

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 NOSOCOMIAL INFECTION
Infection that develops during
hospitalization
One of the leading causes of deaths and
increased morbidity for hospitalized
patients
Also referred to as Hospital Acquired
Infection
Now known as Healthcare- associated
Infection
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 How do infections occur?
INFECTION CYCLE

AGENT

SUSCEPTIBLE SOURCE
HOST

MEANS/MODE OF
TRANSMISSION

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Breaking the Chain of Infection
Levels of Aseptic Control
How Health Care Workers Break the Chain of Infection
Link How Health Care Workers Break the Chain of Infection
Accurate and rapid identification of microorganisms
Infectious or Causative Agent Early recognition of sign and symptoms of infection
Employee health examinations and screenings
Reservoirs Environmental sanitations
Disinfection / Sterilization of instruments
Standard Precautions, Medical Asepsis, Proper Hygiene
Clean gowns, linens, towels, Clean wound dressing
Portal of Exit Handwashing, use of PPE, proper waste disposal, standard
precautions
Method/Mode of Transmission Handwashing, Standard Precautions, Safe food handling,
isolations, use of PPE, transmission based precautions
Aseptic technique, medical or surgical asepsis, wound /
Portal of Entry catheter care, proper disposal, maintain skin integrity,
standard precautions
Susceptible Host Treatment of Disease, Recognition of clients at risk,
immunization, exercise, proper nutrition
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Responsibilities in Infection
Control
Know and comply with infection
control policies and procedures
Recognize potential infection
problems
Report variances
Communicate! Document!
Teach patient and care givers

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Introduction / Background
1945 - introduction of plastic catheters
revolutionized intravenous therapy
Intravenous devices - indispensable in
modern day medical practice
Insertion of an IV catheter - one of the most
commonly performed medical procedures for
various medical indications
IV cannula offers direct access - patients
vascular system; provides a potential route
for entry of microorganisms into that system.
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Indications for Use
Intravenous (IV) therapy should be used only for
definite therapeutic or diagnostic indications
Intravascular catheters/ infusion therapy are
used to:
deliver life-sustaining fluids
monitor the hemodynamic status of critically ill
patients
However, its use is frequently complicated by a
variety of local and/or systemic infectious
complications
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 PATHOGENESIS
Bacteria may gain access to the blood-
stream by 2 principal pathways:
migrate from the catheter skin interface
over the external surface
down the internal surface of the catheter to
the catheter tip

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 PATHOGENESIS
hub - considered to be the initial site of
contamination of the internal surface
pathway bacteria can migrate from hub
to tip of catheter, protected from any host
- defense mechanisms.

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

Other pathways

contamination of
infusate
hematogenous
seeding of the
catheter during
an episode of
secondary
bacteremia

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Guidelines for Prevention of
Intravenous Device-Related Infection
1. Education and training
2. Hand Hygiene
before handling an intravenous catheter
before and after:
- palpating catheter insertion sites
- inserting, replacing / changing,
accessing or dressing an
intravascular device / catheter
gloves do not obviate the need for hand
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
hygiene
 Guidelines for Prevention of
Intravenous Device-Related Infection
3. Aseptic Technique during catheter
insertion and care
cleanse with an appropriate antiseptic

allow antiseptic to remain on insertion site

before inserting catheter
shaving should be avoided if possible
aseptic manipulation of hubs / ports
use of sterile equipment for sterile
procedure
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
4. Barrier Precautions
wear appropriate attire as indicated
by risk of procedure at area of hospital
where the procedure is performed
maximal barrier precautions should
be used during insertion of Central
Venous Catheters (CVCs)
use no-touch dressing technique to
avoid contamination of sterile supplies
/ use sterile gloves for dressing
application
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
5. Surveillance
Purposes
determine device- specific infection
rates
assist in identifying lapses in
infection control practices within the
institution
How to do:
palpate catheter insertion site for tenderness
daily through the intact dressing
visual inspection of catheter site if patient
develops
PHILIPPINE tenderness
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NURSING EDUCATION &site,
RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
Catheter - site dressing regimens
replace catheter-site dressing if the dressing
becomes damp, loosened, or visibly soiled
avoid touch contamination of the catheter
insertion site when the dressing is replaced.
use either sterile gauze or transparent dressing
to cover the catheter site
a gauze dressing is preferred when site is
bleeding or oozing or when patient is diaphoretic
do not use topical antibiotic ointment or creams
on insertion sites

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Guidelines for Prevention of
Intravenous Device-Related Infection
6. Selection and replacement of
intravascular catheters
select the catheter, insertion
technique, and insertion site with the
lowest risk for complications
promptly remove any intravascular
catheter that is no longer essential
do not routinely replace central
venous or arterial catheters solely for
the purposes of reducing the
incidence
PHILIPPINE of infection
HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
replace peripheral venous catheters
at least every 72 - 96 hours to prevent
phlebitis.
leave peripheral venous catheters in
place in children until IV therapy is
completed unless complications occur
when adherence to aseptic technique
cannot be ensured - replace all
catheters as soon as possible (no
longer than 48 hours)
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
7. Replacement of administration sets and
parenteral fluids
replace administration sets no more
frequently than at 72- hour interval
replace tubing used to administer blood,
blood products, or lipid emulsions within
24 hours of initiating the infusion
no recommendations for the hang time of
other parenteral fluids
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
8. Preparation and quality control of IV
admixtures
admix all routine parenteral fluids in the
pharmacy in a laminar-flow hood using aseptic
technique
do not use any container of parenteral fluid that
has visible turbidity, leaks, cracks, or
particulate matter or if the manufacturers
expiration date has passed
use single-dose vials for parenteral additives or
medications when possible
do not combine the leftover content of single-
use vials for later use

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Guidelines for Prevention of
Intravenous Device-Related Infection
If multidose vials are used
refrigerate multidose vials after they
are opened if recommended by the
manufacturer
cleanse the access diaphragm of multidose vials
with 70% alcohol before inserting a device into
the vial
use sterile device to access a multidose vial
and avoid touch contamination of the device
before penetrating the access diaphragm
discard multidose vial if sterility is
compromised
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
 Guidelines for Prevention of
Intravenous Device-Related Infection
9. IV-therapy personnel
designate trained personnel for the insertion
and maintenance of intravascular catheters

10. Prophylactic antimicrobials

do not administer intranasal or systemic
antimicrobial prophylaxis routinely before
insertion or during use of an intravascular
catheter to prevent catheter colonization or
BSI
PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH
No studies had demonstrated that oral
or parenteral antibacterial or
antifungal drugs might reduce the
incidence of CRBSI among adults.

McKee R, Dunsmuir R, Whitby M, Garden OJ. Does

antibiotic prophylaxis at the time of catheter insertion
reduce the incidence of catheter related sepsis in
intravenous nutrition? J Hosp Infect 1985;6:419--25

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Guidelines for Prevention of
Intravenous Device-Related Infection
11. Use of impregnated / coated IV catheters
is there evidence to support its use?
Two meta-analysis demonstrated that
catheters coated with chlorhexidine / silver
sulfadiazine reduced the risk for CRBSI
compared with standard non coated
catheters
Mermel LA. Prevention of intravascular catheter-related
infections. Ann Intern Med 2000; 132:391-402
Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD.
Efficacy of antiseptic-impregnated central venous
catheters in preventing catheter-related bloodstream
infection: a meta-analysis. JAMA 1999;281:261

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 Guidelines for Prevention of
Intravenous Device-Related Infection
12. Environmental Control
clean / disinfect environment routinely
maintain positive pressure in the room
use special treatment room or
operating room
control activity to reduce airborne
transmission if procedures are
done at he bedside

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 LET US BEAR IN MIND
Risk of infectious complications related to
devices is minimized when 3 important
principles are followed:
Devices must be used only as clinically
required and never solely for the health
care providers convenience.
The risks of using a device should always
be considered, and the benefits should
outweigh the risks.
Medical devices should be used only for
the duration of the clinical need.

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH

 LET US BEAR IN MIND
A device that is intended to be disposable or is
labeled for single - patient use should not be
reprocessed for use on another patient unless
processing and packaging and tested routines
have been carefully developed to ensure
sterility/ disinfection, reliable function and
safety.
Any device for vascular access must be considered
a direct conduit between the external world and
its myriad of microorganisms and the blood
stream of the patient

PHILIPPINE HEART CENTER DIVISION OF NURSING EDUCATION & RESEARCH