Infection Prevention for EMS-Placed PIVCs

A Training Course

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Infection Prevention for EMS-Placed PIVCs

ICU Unit Training

Presentation

Summary

Learning sessions

Index

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Presentation

Peripheral Intravenous Catheters (PIVCs) are essential devices that alllowe for the administration of medications and fluids directly into a patient's bloodstream. They are commonly used in hospital settings, particularly in critical care units like the ICU, where rapid intervention is needed. However, while PIVCs are crucial, their use comes with risks, especially when aseptic techniques are not followed. 1. In ICU settings, patients are more susceptibel to infections due to immunocompromise status. This makes infection prevention a top priority. 2. PIVCs inserted outside hospital environments, such as those placed by Emergency Medical Services (EMS) require extra attention to detail as these catheters are often inserted under emergency circumstances, where sterile field is hard to maintain. 3. Making these catheters at risk for contamination and infection, which can complicate patient outcomes and increase healthcare costs.

Introduction

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Goals of the Unit

Reduce Infection Rates

Improve Aspetic Technique

Enhance Nurse Education and Training

Strenghten Policy Adherence

Promote a culture of safety

Goals Of the Unit

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Risks Associated with PIVCs

Significance

Consquences

Why it matters in ICU

increase risk for infection

Lack Aseptic techqnique

EMS-Inserted PIVCs and Increased Risks

Is a "never event"

Can be life threatning

Bloodstream Infections (BSIs):

Risks Associated with PIVCs

Learning sessions

Learning sessions

The Content Of This Module

Infection Prevention Best Practices

Policy on Resiting EMS-Inserted PIVCs

Aseptic Techniques for PIVC Management

2. Recognize and implement critical aseptic measures, including proper hand hygiene and the use of sterile equipment, to minimize infection risks.

1. Master the steps involved in aseptic techniques for PIVC insertion and resiting.

Learning Objectives

Aseptic Techniques for PIVC Management 01

Aseptic Techniques for PIVC Management

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Ensure that all equipment, including catheters, dressings, and antiseptic solutions, is sterile. Use a sterile tray to organize supplies.

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Wear appropriate PPE, such as gloves and a mask, to maintain a sterile field and prevent contamination depending on the line (most PIVs just need the use of gloves)

Begin by washing hands thoroughly with soap and water or using an alcohol-based hand sanitizer.

Preparation of Equipment:

Personal Protective Equipment (PPE):

Hand Hygiene

Step-by-Step Aseptic Procedure for PIVC Resiting

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Apply a transparent, sterile dressing over the insertion site. Use CHG-impregnated dressings, as recommended by Panepinto, Harris, & Wellette (2021), to further reduce infection risks.

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Carefully insert the catheter without touching any non-sterile surfaces. Ensure that the insertion site is properly secured with a sterile dressing.

Use chlorhexidine-alcohol for skin preparation, as supported by Guenezan et al. (2019), who demonstrated its superior efficacy compared to povidone iodine-alcohol. Apply the antiseptic solution in a back-and-forth motion and allow it to dry completely.

Dressing and Securing:

Insertion Technique:

Skin Antisepsis

Step-by-Step Aseptic Procedure for PIVC Resiting

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The use of a facility approve video to demostrate the proper insertion techqnique of a PIV. I would also create an interactive checklist where nurses can tick off each step as they review the procedure, reinforcing the importance of following each step precisely.

Video Demonstration

Learn the evidence-based rationale for this practice.

Uderstand the hospital policy for resiting PIVCs placed by EMS.

Learning Objectives

Policy on Resiting EMS-Inserted PIVCs

Policy on Resiting EMS-Inserted PIVCs

Challenges

steps to implement

Risks of noncompliance

Overview of Policy

Evidence-Based Rationale for Resiting Research Findings: Gollinga et al. (2023): Highlight that EMS-inserted PIVCs have a higher contamination rate due to emergency field conditions, such as limited access to sterile equipment and the urgency of care. CDC Guidelines (2022): The CDC emphasizes the importance of prioritizing infection control in high-risk environments like the ICU. The “Targeted Assessment for Prevention (TAP)” strategy guides hospitals in identifying and addressing infection risks. Panepinto, Harris, & Wellette (2021): This study found that using chlorhexidine-impregnated dressings and resiting catheters placed outside hospital settings significantly reduces bloodstream infections.

Hospital Policy: The policy mandates that all PIVCs inserted by EMS must be resited within 24 hours of admission to the ICU, regardless of their appearance or functionality. The aim is to mitigate the risk of infection associated with catheters inserted in non-sterile environments. Purpose: The policy was developed to ensure patient safety and adherence to the highest standards of infection prevention. It aligns with best practices recommended by healthcare authorities such as the Centers for Disease Control and Prevention (CDC).

Overview of the Policy

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What are the most common complications associated with PIVCs?

C. both A and B

B. Bloodstream infection

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A. Phlebitis

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Peripheral Intravenous Catheters (PIVCs) can lead to serious complications if not managed properly. Phlebitis is the inflammation of the vein, often caused by irritation or infection from the catheter. Bloodstream infections (BSIs) occur when bacteria enter the bloodstream via the catheter insertion site, which can be life-threatening, especially in ICU patients.

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How long should you allow the antiseptic solution to dry before inserting the PIVC?

C. 15 seconds

B.30 seconds

A. 5 seconds

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Proper antiseptic application requires a drying time of at least 30 seconds to 1 minute. This ensures that the antiseptic has enough time to eliminate bacteria effectively and create a protective antimicrobial barrier

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What is the primary reason for resiting an EMS-inserted PIVC upon ICU admission?

C. To Reduce the Risk of Infection

B. To ensure better catheter placement

A. To improve medication delivery

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The primary reason for resiting an EMS-inserted PIVC upon ICU admission is to reduce the risk of infection. PIVCs placed by Emergency Medical Services (EMS) are often inserted under emergency conditions, where maintaining a sterile field may not be possible. This increases the likelihood of contamination, which could lead to serious infections like bloodstream infections (BSIs). Resiting the catheter in a controlled, sterile hospital environment significantly reduces this risk and ensures adherence to infection prevention standards.

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Why is it important to apply a sterile, transparent dressing over the PIVC insertion site?

A. To reduce the risk of infection by protecting the site from contaminants

B.To make the patient more comfortable

C.To keep the catheter from moving

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Applying a sterile, transparent dressing over the PIVC insertion site is essential to reduce the risk of infection. The dressing acts as a protective barrier, preventing contaminants from entering the insertion site and causing infections like bloodstream infections (BSIs). Additionally, the transparency of the dressing allows healthcare providers to monitor the site for signs of infection or complications without removing the dressing, ensuring ongoing assessment and patient safety.

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What should you do if the sterile field is accidentally contaminated during a PIVC insertion procedure?

B. Discard contaminated supplies and re-establish the sterile field

C.Ignore the contamination if it appears minor

A. Continue the procedure to avoid wasting time

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If the sterile field is accidentally contaminated, it is crucial to discard any contaminated supplies and re-establish the sterile field before proceeding. Maintaining sterility is a fundamental aspect of preventing infections, especially in ICU patients who are highly vulnerable. Ignoring contamination or continuing the procedure can introduce harmful pathogens into the bloodstream, increasing the risk of serious complications. Taking the time to reset the sterile field ensures the highest standard of infection prevention.

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RECOGNIZE THE IMPORTANCE OF CONTINOUS ADHERENCE

APPLY REASEARCH FINDINGS TO DEVELOP A PROACTIVE APPROACH

iMPLEMENT EVIDENCE BASED INFECTION PREVENTION STRATEGIES

Learning Objectives

Infection Prevention Best Practices

Infection Prevention Best Practices

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Using Antiseptics Effectively

monitoring and assesment

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Prevention

Importance in ICU Settings: Infection prevention is a top priority in the ICU, where patients are highly susceptible to hospital-acquired infections (HAIs). Best practices not only improve patient outcomes but also reduce the overall burden on healthcare systems. Chlorhexidine Gluconate (CHG) Dressings: Panepinto, Harris, & Wellette (2021) highlight the use of CHG-impregnated dressings as a critical measure in reducing bloodstream infections. CHG dressings provide an antimicrobial barrier around the catheter insertion site. Routine Site Assessment: Regularly evaluate the PIVC insertion site for signs of infection, such as redness, swelling, or discharge. Promptly remove or replace any PIVC that shows signs of complications.

Overview of Infection Prevention Strategies

Regular audits, nurse feedback, and ongoing education are essential to ensure compliance with infection prevention protocols and improve patient safety.

Hospital policy requires resiting EMS-inserted PIVCs within 24 hours to ensure sterility and reduce infection risks, supported by evidence-based research.

Proper hand hygiene, the use of antiseptic solutions like chlorhexidine-alcohol, and strict maintenance of the sterile field are crucial to prevent infections.

PIVCs, especially those inserted by EMS, pose a significant risk for bloodstream infections in ICU patients due to non-sterile emergency conditions.

Continuous Monitoring:

Aseptic Techniques:

Policy on Resiting:

Infection Risks

Summary

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Why don't you try it again? Be brave!

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Using Antiseptics Effectively

Chlorhexidine-Alcohol vs. Povidone Iodine-AlcoholResearch Evidence: A randomized controlled trial conducted by Guenezan et al. (2019) compared the effectiveness of chlorhexidine-alcohol to povidone iodine-alcohol for skin antisepsis. The results showed that chlorhexidine-alcohol significantly reduced PIV-related infection rates compared to povidone iodine-alcohol. This evidence supports the recommendation for using chlorhexidine-alcohol as the preferred antiseptic in ICU settings. Mechanism of Action: Chlorhexidine-alcohol works by rapidly destroying bacterial cell walls and providing a persistent antimicrobial effect on the skin. This makes it particularly effective in high-risk environments where preventing contamination is crucial.

The Risks of Not Following the Policy

Increased Infection Rates: Failure to resite EMS-inserted PIVCs has been linked to higher rates of bloodstream infections (BSIs) and phlebitis. Pathogens introduced at the insertion site can quickly lead to systemic infections in ICU patients. Case Example: Discuss a real or hypothetical case where a patient developed severe sepsis due to an EMS-inserted PIVC that was not resited promptly. This highlights the potential consequences of non-compliance.

Continuous Monitoring and Assessment

Regular AuditsPurpose: Audits serve as a quality assurance measure to evaluate adherence to aseptic techniques and infection control practices. They help identify gaps in compliance and areas where additional training or resources may be needed. Implementation: Infection control teams will conduct bi-weekly audits of PIVC procedures. Auditors will observe practices such as hand hygiene, proper antiseptic use, and the maintenance of sterile fields. Audit Findings: The results of these audits will be shared in unit meetings, and any decline will be addressed promptly. For instance, if an audit reveals that hand hygiene practices are inconsistent, targeted reminders and additional education sessions will be provided.

Preventing Contamination During PIVC Management

Minimize Touch Points: Once the sterile field is prepared, avoid touching anything that could contaminate the site or equipment. If contamination occurs, start over with a new sterile setup.Proper Securing and Dressing: Ensure that the PIVC is properly secured to prevent movement, which can introduce bacteria into the bloodstream. Use a sterile, transparent dressing to monitor the insertion site.

Addressing Common Challenges

Time Constraints: ICU settings are often busy, and resiting PIVCs may seem time-consuming. However, emphasize that the long-term benefits, such as reduced infection rates, outweigh the temporary inconvenience.Patient Concerns: Patients or their families may question the need for resiting. Use clear explanations to reassure them of the procedure’s importance in preventing serious infections and teach back method if needed.

Steps to Implement the Policy

Assessment: Upon ICU admission, assess the patient’s PIVC for signs of infection or malfunction. Even if the PIVC appears normal, the policy requires resiting to ensure a sterile insertion.

Procedure:

• Follow strict aseptic techniques as outlined in Module 2.
• Use evidence-based antiseptic solutions, such as chlorhexidine-alcohol, before inserting the new catheter.
• Document the procedure thoroughly, noting the reason for resiting and the condition of the original PIVC.