[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Preventing Infections Associated with Indwelling Intravascular Access Devices

Quality Assurance and Improvement

Measures to minimize the risk of infection associated with intravascular therapy must strike a balance between patient safety, cost-effectiveness, and pragmatism. As knowledge, technology and health care settings change, infection control and prevention measures must change. This implies the need for well-organized programs that provide, monitor and evaluate care, as well as for the education of all involved. Reports spanning the past two decades have consistently found that risk of infection declines following standardization of aseptic care^(10-14). Specialized "IV teams", a logical consequence of this evidence, have documented effectiveness^(15,16). However, the cost-effectiveness of such teams and the extent to which their impact is due to increased skill rather than increased staffing are unclear.

RECOMMENDATIONS

Program Organization

1. Written policies and procedures concerning infection prevention in the administration of intravascular therapy should be included in the infection prevention program of each institution or organization, and should be reviewed at least annually⁽³⁾. (Category A; Grade III)

2. Each institution or organization should ensure access to the expert advice of physicians, intravascular therapy nurse specialists, pharmacists, and infection control practitioners in maintaining its policies and procedures⁽³⁾. (Category A; Grade III)

3. Each organization should ensure that an effective surveillance system is in place to identify intravascular-associated infections⁽³⁾. (Category A; Grade III)

4. Personnel

1. Each institution or organization should ensure that all those providing care, including emergency response attendants, nurses and physicians, maintain a high level of skill through regularly scheduled training and adhere to approved policies and procedures pertinent to intravascular therapy. An IV therapy team will facilitate maintenance of a high level of skill⁽¹⁷⁾. (Category A; Grade I)
2. Patients should have timely access to skilled practitioners throughout the duration of intravascular therapy. (Category A; Grade III)

5. Patient education

1. Each institution or organization should ensure that patients understand the nature of the intravascular therapy they are receiving, the importance of hand washing, asepsis and other safety measures, recognize early indications of infection or other complications, and know to whom they should report complications. (Category B; Grade III)
2. The method of delivery and extent of education provided should be tailored to meet the needs of the individual patient. (Category B; Grade III)

6. Surveillance of intravascular device-associated infections

   1. Clear definitions of intravascular device-associated infections should be established. These may differ from those used for clinical or research purposes. Since patients may not recognize the signs and symptoms of infection⁽¹⁸⁾, outpatient and home care intravascular therapy services must be particularly diligent to ensure effective teaching and monitoring of patients⁽³⁾. (Category A; Grade III)
   2. Rates of infection should be expressed in terms of infections per 1,000 device-days, stratified by type of device and patient group. Rates of device use should also be evaluated⁽¹⁹⁾. (See Appendix IV for an example of how to calculate rates per 1,000 device-days.) The procedures used for data collection and the personnel to be involved should be determined according to the needs and resources of a given organization. Analysis and reporting of infection rates may be continuous or periodic, at the discretion of individual organizations. Documentation of intravascular device use and related procedures is essential to an effective surveillance program. The minimum documentation required includes insertion sites, type(s) of device, procedure or therapy, date inserted or replaced, date removed, and individual performing the procedure. (Category A; Grade III)
   3. Compliance with intravascular therapy policies and procedures regarding insertion technique and care of insertion sites and devices should be evaluated on a regular basis. (Category A; Grade III)iv) Infection rates should be evaluated in three ways:

      by comparing rate of infections against external "best-of-practice" examples (Benchmarking [see Appendix III]);

      by comparing rate of infections with published rates in the literature (see Table 5, Appendix IV); and

      by monitoring the rate over time to detect trends. (Category B; Grade III)

7. The optimal time limit for replacing catheters, administration sets, or fluid containers depends upon individual circumstances. Duration of use limits and the priority assigned to corrective measures should be established relative to reported aggregate infection rates and, where possible, to established benchmarks. Facilities that fail to achieve low infection rates should consider adopting more conservative limits. (Category B; Grade III)

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