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Hi Everyone,
At Western Health currently the procedure for Peripheral IV cannulas (PIVC) inserted by ambulance personnel in the community, and any PIVC that are inserted in a non-sterile manner in hospital (e.g. emergency situation) are resited within 24 hours. Due to an increase in cannula related infections and amongst other actions, which I’m happy to share, we are also considering to resite all PIVCs inserted by ambulance and all those inserted in the Emergency departments immediately after admission to the wards rather than within 24 hours.
Has any other hospital taken this approach?Regards,
RichardRichard Bartolo
Manager Infection PreventionWestern Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. http://www.westernhealth.org.au[cid:image002.jpg@01D09E96.0FC38820]
C ompassion, A ccountability, R espect, E xcellence, S afety[cid:image004.png@01D09E96.0FC38820]
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Dear Richard, I’m interested to know what you think is behind this increase
in infections? Is it for example the skin prep, hand hygiene, or the
re-palpation after skin prep?We discovered a few years ago that the ambulance were not using CHG in
alcohol for their skin prep, even though the hospital had moved to that.
Once this came to the ambulance’s attention they swiftly moved to implement
it in the pre-hospital as well.In our older, fatter population, preserving veins is important, and in our
analysis of nearly 6000 PIVs (ICHE 2014 Wallis et al), once the first
catheter is removed for whatever reason, the subsequent ones had a
statistically significant 20% higher rate of failure
(occlusion/infiltration etc), presumably due to the ‘best vein’ being
chosen first.While stop-gap measures may be needed during a ‘spike’, my personal belief
is that it is important to get to the root of the problem, ideally patients
should only need one PIV for the course of their entire admission. It’s our
job to find safe ways of providing that venous access, and we need to work
throughout our departments rather than ending up with the ambulance PIV, ED
PIV, Radiology PIV and Anaesthetic PIV (no joke, we see thisfrequently,
with all lines still being in).Good luck with this interesting problem 🙂 PM me if you would like to chat
off-line.All the best
Claire
Claire Rickard RN PhD, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland, Griffith University
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal
Brisbane & Women’s HospitalsOn 4 June 2015 at 07:14, Bartolo, Richard wrote:
> Hi Everyone,
>
> At Western Health currently the procedure for Peripheral IV cannulas
> (PIVC) inserted by ambulance personnel in the community, and any PIVC that
> are inserted in a non-sterile manner in hospital (e.g. emergency situation)
> are resited within 24 hours. Due to an increase in cannula related
> infections and amongst other actions, which Im happy to share, we are also
> considering to resite all PIVCs inserted by ambulance and all those
> inserted in the Emergency departments immediately after admission to the
> wards rather than within 24 hours.
>
> Has any other hospital taken this approach?
>
>
>
> Regards,
>
> Richard
>
>
>
> *Richard Bartolo*
> *Manager Infection Prevention*
>
> Western Health
>
> Gordon Street, Footscray VIC 3011
> Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
> Mob. 0438 560 441
>
> Email. richard.bartolo@wh.org.au
> Web. http://www.westernhealth.org.au
>
>
> [image: 2010wh_logo]
>
> *C* *ompassion**, **A* *ccountability**, **R* *espect**, **E **xcellence**,
> **S* *afety*
>
>
>
> [image: cid:image001.png@01CF0875.78B557E0]
>
>
>
> Notice:
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Hi Richard
We routinely resite any PIV cannula that is in insitu on admission at 24 hours, regardless of where it was inserted (we cannot be sure it was not inserted under emergency conditions). One of the changes we are making now is to routinely resite all PIV cannulas inserted into the antecubital fossa site within 24 hours. We have seen some significant infections in this site, and although we cannot generate a large enough sample to be statistically significant, we think this might reduce both the selection of the antecubital fossa as a site and also reduce the risk of PIV site infections and related bacteraemias. Our ID physician is driving this change.
PIV related bacteraemias do not occur in large enough numbers to make statistically significant observations in small sample sizes, so it may be difficult without enrolling a million or so cannulas (that’s a plug for some current research, by the way… 🙂 ).
I think making these types of changes needs to be discussed at the local level, taking all of your current local factors into account. It will be hard to power studies to provide evidence for such changes, though.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHi Everyone,
At Western Health currently the procedure for Peripheral IV cannulas (PIVC) inserted by ambulance personnel in the community, and any PIVC that are inserted in a non-sterile manner in hospital (e.g. emergency situation) are resited within 24 hours. Due to an increase in cannula related infections and amongst other actions, which I’m happy to share, we are also considering to resite all PIVCs inserted by ambulance and all those inserted in the Emergency departments immediately after admission to the wards rather than within 24 hours.
Has any other hospital taken this approach?Regards,
RichardRichard Bartolo
Manager Infection Prevention
Western Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. http://www.westernhealth.org.au[2010wh_logo]
C ompassion, A ccountability, R espect, E xcellence, S afety[cid:image001.png@01CF0875.78B557E0]
Notice:
This email (and any attachment) is for the exclusive use of the addressee and may contain information that is privileged, confidential or protected by copyrights. If you are not the addressee or the person responsible for delivering this email to the addressee, you must not disclose, distribute, print or copy this email and the contents must be kept strictly confidential. If this email has been sent to you in error, kindly notify us immediately on 03 8345 56113 and destroy the original. Electronic mail is not secure and there is also a risk that it may be corrupted in transmission. It is therefore your responsibility to check this email (and any attachment) carefully and if there are any errors to contact us immediately. We do not accept liability for any loss or damage caused by such lack of security or transmission errors.______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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HI Michael
Interesting…
I know this list is interested in infection 🙂 but I think we would see
better PIV results overall with that approach Michael – compared to a
forearm insertion, ACF insertion HR 1.3 times the risk of
occlusion/infiltration and HR *1.7 times the risk of the accidental
removal. *The hand is even worse…(Wallis et al ICHE 2014, attached)
Of course, it would be optimal if the PIV was placed in the forearm, using
aseptic non touch technique and correct skin preparation, in the first
place 😀 I am talking about PIVs we want to use for ongoing
medicine/infusion of course. Procedural PIVs could still be in the hand/ACF
as long as they are removed afterwards.Glad PIVs are getting emphasis these days, as well as CVADs!!
C
Claire Rickard RN PhD, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland, Griffith University
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal
Brisbane & Women’s HospitalsOn 4 June 2015 at 09:57, Michael Wishart
wrote:> Hi Richard
>
>
>
> We routinely resite any PIV cannula that is in insitu on admission at 24
> hours, regardless of where it was inserted (we cannot be sure it was not
> inserted under emergency conditions). One of the changes we are making now
> is to routinely resite all PIV cannulas inserted into the antecubital fossa
> site within 24 hours. We have seen some significant infections in this
> site, and although we cannot generate a large enough sample to be
> statistically significant, we think this might reduce both the selection of
> the antecubital fossa as a site and also reduce the risk of PIV site
> infections and related bacteraemias. Our ID physician is driving this
> change.
>
>
>
> PIV related bacteraemias do not occur in large enough numbers to make
> statistically significant observations in small sample sizes, so it may be
> difficult without enrolling a million or so cannulas (thats a plug for
> some current research, by the way J ).
>
>
>
> I think making these types of changes needs to be discussed at the local
> level, taking all of your current local factors into account. It will be
> hard to power studies to provide evidence for such changes, though.
>
>
>
> Cheers
>
> Michael
>
>
>
>
>
> *Michael Wishart*
>
> Infection Control Coordinator
>
>
> *A *627 Rode Road, Chermside QLD 4032
> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
> [image: cid:image001.png@01D01926.61F1C2B0]
> P *Please consider the environment before printing this email*
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Bartolo, Richard
> *Sent:* Thursday, 4 June 2015 7:14 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Peripheral IV cannulas inserted in unfavourable conditions
>
>
>
> Hi Everyone,
>
> At Western Health currently the procedure for Peripheral IV cannulas
> (PIVC) inserted by ambulance personnel in the community, and any PIVC that
> are inserted in a non-sterile manner in hospital (e.g. emergency situation)
> are resited within 24 hours. Due to an increase in cannula related
> infections and amongst other actions, which Im happy to share, we are also
> considering to resite all PIVCs inserted by ambulance and all those
> inserted in the Emergency departments immediately after admission to the
> wards rather than within 24 hours.
>
> Has any other hospital taken this approach?
>
>
>
> Regards,
>
> Richard
>
>
>
> *Richard Bartolo*
> *Manager Infection Prevention*
>
> Western Health
>
> Gordon Street, Footscray VIC 3011
> Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
> Mob. 0438 560 441
>
> Email. richard.bartolo@wh.org.au
> Web. http://www.westernhealth.org.au
>
>
> [image: 2010wh_logo]
>
> *C* *ompassion**, **A* *ccountability**, **R* *espect**, **E **xcellence**,
> **S* *afety*
>
>
>
> [image: cid:image001.png@01CF0875.78B557E0]
>
>
>
> Notice:
> This email (and any attachment) is for the exclusive use of the addressee
> and may contain information that is privileged, confidential or protected
> by copyrights. If you are not the addressee or the person responsible for
> delivering this email to the addressee, you must not disclose, distribute,
> print or copy this email and the contents must be kept strictly
> confidential. If this email has been sent to you in error, kindly notify us
> immediately on 03 8345 56113 and destroy the original. Electronic mail is
> not secure and there is also a risk that it may be corrupted in
> transmission. It is therefore your responsibility to check this email (and
> any attachment) carefully and if there are any errors to contact us
> immediately. We do not accept liability for any loss or damage caused by
> such lack of security or transmission errors.
>
>
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> Archive of all messages are available at http://aicalist.org.au/archives
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> Replies to this message will be directed back to the list. To create a new
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> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
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> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
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Dear Andrew
No we have not taken this direct approach at present but other work has been undertaken to address this concern & I largely can only speak for my experience what I also know NSW ambulance are doing which is being driven by Kate Hipsley their Infection prevention & control manager and data I have to hand locally . Other sites within NSW may have a different view
In NSW all PHO (including ambulance ) are guided by our PIVC insertion & post insertion GL (attached) and in feedback from stakeholders such as ambulance it was identified that not ALL PIVCs that are inserted by them are undertaken in an emergency situation and I am assured by Kate Hipsley (NSW Ambulance ICP) that they are assessed to insert using PIVCs using aseptic technique in the first instance and are they are also required to place an big yellow AMBULANCE insertion sticker and date indicating they are inserted using aseptic technique, which I know Kate reviews and audits as she can ( …when she came to my site recently to do some workshops with local command to do VHF training she also spent some time checking pts arriving via ambulance with PIVCs inserted as they came in the ED door ……along with their Hand hygiene & cleaning etc….so although sporadic I saw for myself at the coal face that the message is slowly getting through…. They all knew who she was and what she was looking for …she is a bit of a superwoman …I reckon!!! ).
So If they are inserted in an emergency situation by ambo then they wont be stickered and yes do need to be reviewed re if they are needed and replaced….
Interestingly Additional Feedback from other NSW stakeholders prior to the release of NSW PIVC guideline – particularly rural/ remote / smaller PHO indicated that they may not always have another person available to re sight a PIVC (particularly if the person had difficult / poor access as part of their condition- chronic/acute etc ) that get inserted in an emergency situation or arrive at their service/ clinic with an ambo inserted PIVC to be able to readily change them (even within 24hrs) – so the NSW guidelines considered the feedback and decided to not just target ambulance but to provide advice as per below & the time frame to be a recommendation rather than a mandate to raise (& also to in the first instance to consider if there is even a need to have another inserted – rather than just routinely change as standard)
9.4.4 Remove PIVCs that may have been inserted without full aseptic procedure (e.g. emergency situation) as soon as practical, preferably within 24 hours, and replace if clinically warranted.
I do know that Our NSW Ambulance Infection Prevention & Control manager Kate Hipsely has undertaken a lot of great work and consultation with her ambulance management & staff across NSW in regard to insertion, care, documentation and management of PIVC and she is constantly engaging NSW ICPs/ facilities regarding PIVC/BSIs infections related to ambulance insertions – so she would be best placed to provide feedback on what NSW is seeing in regard to ambulance inserted PIVC related infections/BSI from her end. Perhaps your Victorian ambulance service Infection control officer is doing something similar?
I know from my experience I don’t recall coming across any pts that I have been able to directly link to BSI’s here or in my previous role to ambos in a long time …although not so sure about PIVC site infections (as I don’t believe I can hand on my heart that I get them all reported to me …no matter how much I ask/ push staff to report ..so cant be 100% here!) & I have like many ICP s agreed to provide Kate with data/ feedback if & when we do see any infections from ambo PIVC insertions (so she can follow up to assist with evaluating the work she has been doing) ) .
Also I am unable to clearly define that the PIVCs/BSIs I am seeing are directly related to urgent/ emergency insertions ….in this and my last role its seems I saw more cases related to ?poor compliance with asepsis during standard insertion procedure (+ documentation)… and more markedly post procedure care & monitoring (+documentation again)…often the boxes are ticked on the paperwork but when I speak with the pts there are differences???… again it seems we still insert too many routinely and do not get them out quickly enough given staff now seem to see them as normal part of a pt being in hospital and a safety thing for them to have access & not as a dangerous risk…… (although our insertion/aseptic technique audits say we are doing fine???) …my current data on PIVC infection is low though so I may be a little harsh & picky….
Given we all know that insertion for PIVCs is the highest risk point for an infection we are all hoping to avoid unnecessary PIVC insertion where we can …hence me acknowledging Kate from NSW ambulance ICP has been very proactive & forward thinking with her managements support in promoting and educating around preventing PIVC even needing insertion by Ambos if no access is needed based on pt condition …even if they are needing to be transferred to an acute service (again I think you could contact her re feedback with the success around with reducing this risk and what data she may be getting from other ICPs re PIVC infections related to ambo insertion)
In a former role a decision was made / supported by senior clinicians/ dept. head in one area where they were seeing higher BSI rates related to PIVCs that the medical team would be required to consider / agree to pts ongoing need to have a PIVC institute as part of accepting their admission to the ward (s) & they if they did need to have a PIVC they had to check & document their condition every day as part of their medical daily review standard checklist protocol for the JMO
.
The department head would get a daily base count number of how many pts in each ward had a PIVC & challenge them as to why there was that number) . It was actually amazing to see the number of pts each day in the ward(s) with a PIVC dramatically decrease as a result almost instantly and hence the BSI rate decrease (maybe not a very scientific approach but it worked) ……..perhaps its education/ processes/ joint management- clinician push re getting staff to consider other options & not insert / remove more promptly and alternate therapy considered more rapidly rather than to look to mandating replacement in the first instance? Just a thought …I know there are far more experts in IV insertion, management and data than me who may have more value to add?Anyhow hope this feedback useful
Kind regards
Lindy
Lindy Ryan
Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.auHi Everyone,
At Western Health currently the procedure for Peripheral IV cannulas (PIVC) inserted by ambulance personnel in the community, and any PIVC that are inserted in a non-sterile manner in hospital (e.g. emergency situation) are resited within 24 hours. Due to an increase in cannula related infections and amongst other actions, which I’m happy to share, we are also considering to resite all PIVCs inserted by ambulance and all those inserted in the Emergency departments immediately after admission to the wards rather than within 24 hours.
Has any other hospital taken this approach?Regards,
RichardRichard Bartolo
Manager Infection Prevention
Western Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. http://www.westernhealth.org.au[2010wh_logo]
C ompassion, A ccountability, R espect, E xcellence, S afety[cid:image001.png@01CF0875.78B557E0]
Notice:
This email (and any attachment) is for the exclusive use of the addressee and may contain information that is privileged, confidential or protected by copyrights. If you are not the addressee or the person responsible for delivering this email to the addressee, you must not disclose, distribute, print or copy this email and the contents must be kept strictly confidential. If this email has been sent to you in error, kindly notify us immediately on 03 8345 56113 and destroy the original. Electronic mail is not secure and there is also a risk that it may be corrupted in transmission. It is therefore your responsibility to check this email (and any attachment) carefully and if there are any errors to contact us immediately. We do not accept liability for any loss or damage caused by such lack of security or transmission errors.MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Thanks for the topic Richard, and thanks Lindy for the kind words.
Paramedics are trained and credentialed to perform IV cannulation, however is impossible to guarantee that all NSW Ambulance inserted cannulas are done aseptically. They could be inserted in people’s bedrooms, in bathrooms or toilets, on sporting fields or in confined locations eg MVAs and in every different possible weather condition.
We have worked to improve our procedure (chlorhexidine/alcohol swabs used), equipment and dressing/labelling techniques. We have also worked to address attitudes regarding cannulation ie does this patient need a cannula? If the paramedic intends to, or thinks they may need to provide IV treatment, then they should cannulate. However we discourage those cannulas that are only done to make the hospital / triage staff happy.
Our procedure is to document the date and time of IVC insertion on the IV dressing, and then because our IVC dressings look like hospital IVCs, the procedure stipulates a yellow AMBULANCE INSERTED sticker be placed on all of our IVC dressings. Hospitals can then decide which AMBULANCE INSERTED cannulas to change, remove etc on a local basis.
We currently ask 4 Local Health Districts (LHDs) in NSW to provide quarterly feedback about any SABSIs they have identified related to NSW Ambulance inserted cannulas. We investigate each report, request feedback from the inserting clinician and then feedback to our Clinical Governance Committee. We also appreciate any LHD or facility approaching us directly with this information at any time – see my contact details below.
The majority of SABSIs reported to us are related to Ambulance IVs that are kept in by the facilities for an extended period of time and usually >24 hours.
Happy to discuss off line as needed.
Regards to all,
Kate Hipsley
Manager, Infection Control | Clinical Services
Balmain Road, ROZELLE NSW 2039
p: 02 9320 7868 | m: 0428 238 789 | f: 02 9320 7729 | khipsley@ambulance.nsw.gov.au
http://www.ambulance.nsw.gov.au
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—————————————————————————————————————————————————-Dear Andrew
No we have not taken this direct approach at present but other work has been undertaken to address this concern & I largely can only speak for my experience what I also know NSW ambulance are doing which is being driven by Kate Hipsley their Infection prevention & control manager and data I have to hand locally . Other sites within NSW may have a different view
In NSW all PHO (including ambulance ) are guided by our PIVC insertion & post insertion GL (attached) and in feedback from stakeholders such as ambulance it was identified that not ALL PIVCs that are inserted by them are undertaken in an emergency situation and I am assured by Kate Hipsley (NSW Ambulance ICP) that they are assessed to insert using PIVCs using aseptic technique in the first instance and are they are also required to place an big yellow AMBULANCE insertion sticker and date indicating they are inserted using aseptic technique, which I know Kate reviews and audits as she can ( …when she came to my site recently to do some workshops with local command to do VHF training she also spent some time checking pts arriving via ambulance with PIVCs inserted as they came in the ED door ……along with their Hand hygiene & cleaning etc….so although sporadic I saw for myself at the coal face that the message is slowly getting through…. They all knew who she was and what she was looking for …she is a bit of a superwoman …I reckon!!! ).
So If they are inserted in an emergency situation by ambo then they wont be stickered and yes do need to be reviewed re if they are needed and replaced….
Interestingly Additional Feedback from other NSW stakeholders prior to the release of NSW PIVC guideline – particularly rural/ remote / smaller PHO indicated that they may not always have another person available to re sight a PIVC (particularly if the person had difficult / poor access as part of their condition- chronic/acute etc ) that get inserted in an emergency situation or arrive at their service/ clinic with an ambo inserted PIVC to be able to readily change them (even within 24hrs) – so the NSW guidelines considered the feedback and decided to not just target ambulance but to provide advice as per below & the time frame to be a recommendation rather than a mandate to raise (& also to in the first instance to consider if there is even a need to have another inserted – rather than just routinely change as standard)
9.4.4 Remove PIVCs that may have been inserted without full aseptic procedure (e.g. emergency situation) as soon as practical, preferably within 24 hours, and replace if clinically warranted.
I do know that Our NSW Ambulance Infection Prevention & Control manager Kate Hipsely has undertaken a lot of great work and consultation with her ambulance management & staff across NSW in regard to insertion, care, documentation and management of PIVC and she is constantly engaging NSW ICPs/ facilities regarding PIVC/BSIs infections related to ambulance insertions – so she would be best placed to provide feedback on what NSW is seeing in regard to ambulance inserted PIVC related infections/BSI from her end. Perhaps your Victorian ambulance service Infection control officer is doing something similar?
I know from my experience I don’t recall coming across any pts that I have been able to directly link to BSI’s here or in my previous role to ambos in a long time …although not so sure about PIVC site infections (as I don’t believe I can hand on my heart that I get them all reported to me …no matter how much I ask/ push staff to report ..so cant be 100% here!) & I have like many ICP s agreed to provide Kate with data/ feedback if & when we do see any infections from ambo PIVC insertions (so she can follow up to assist with evaluating the work she has been doing) ) .
Also I am unable to clearly define that the PIVCs/BSIs I am seeing are directly related to urgent/ emergency insertions ….in this and my last role its seems I saw more cases related to ?poor compliance with asepsis during standard insertion procedure (+ documentation)… and more markedly post procedure care & monitoring (+documentation again)…often the boxes are ticked on the paperwork but when I speak with the pts there are differences???… again it seems we still insert too many routinely and do not get them out quickly enough given staff now seem to see them as normal part of a pt being in hospital and a safety thing for them to have access & not as a dangerous risk…… (although our insertion/aseptic technique audits say we are doing fine???) …my current data on PIVC infection is low though so I may be a little harsh & picky….
Given we all know that insertion for PIVCs is the highest risk point for an infection we are all hoping to avoid unnecessary PIVC insertion where we can …hence me acknowledging Kate from NSW ambulance ICP has been very proactive & forward thinking with her managements support in promoting and educating around preventing PIVC even needing insertion by Ambos if no access is needed based on pt condition …even if they are needing to be transferred to an acute service (again I think you could contact her re feedback with the success around with reducing this risk and what data she may be getting from other ICPs re PIVC infections related to ambo insertion)
In a former role a decision was made / supported by senior clinicians/ dept. head in one area where they were seeing higher BSI rates related to PIVCs that the medical team would be required to consider / agree to pts ongoing need to have a PIVC institute as part of accepting their admission to the ward (s) & they if they did need to have a PIVC they had to check & document their condition every day as part of their medical daily review standard checklist protocol for the JMO
The department head would get a daily base count number of how many pts in each ward had a PIVC & challenge them as to why there was that number) . It was actually amazing to see the number of pts each day in the ward(s) with a PIVC dramatically decrease as a result almost instantly and hence the BSI rate decrease (maybe not a very scientific approach but it worked) ……..perhaps its education/ processes/ joint management- clinician push re getting staff to consider other options & not insert / remove more promptly and alternate therapy considered more rapidly rather than to look to mandating replacement in the first instance? Just a thought …I know there are far more experts in IV insertion, management and data than me who may have more value to add?
Anyhow hope this feedback useful
Kind regards
Lindy
Lindy Ryan
Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.auHi Everyone,
At Western Health currently the procedure for Peripheral IV cannulas (PIVC) inserted by ambulance personnel in the community, and any PIVC that are inserted in a non-sterile manner in hospital (e.g. emergency situation) are resited within 24 hours. Due to an increase in cannula related infections and amongst other actions, which I’m happy to share, we are also considering to resite all PIVCs inserted by ambulance and all those inserted in the Emergency departments immediately after admission to the wards rather than within 24 hours.
Has any other hospital taken this approach?Regards,
RichardRichard Bartolo
Manager Infection Prevention
Western Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. http://www.westernhealth.org.au[2010wh_logo]
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