Running head: PREVENTING INTRAVENOUS INFECTIONS
Using Evidenced Based Practice to Prevent Intravenous Therapy Related Infections
Rebecca Cavanagh
Ferris State University
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Preventing Intravenous Infections
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Introduction
Intravenous Therapy is a common intervention in both acute and long term health care
settings. They allow a direct route for fluids blood products, drugs and parental nutrients into the
bloodstream (Ho, 2012). There are many different types of appliances through which
intravenous therapy is delivered. Central venous access devices and peripheral intravenous are
the two that will be focused on. These devices and the therapy they deliver greatly help patients
in their recovery, but they can also lead to infections. These infections increase patient morbidity
and mortality (Scales, 2011). Intravenous devices are started with needles and catheters are left
in place to keep the site open and deliver the therapies. These catheters can become contaminated
and work its way into the blood stream causing infection.
Types of Infection /Complications
Catheter-related blood stream infections and phlebitis are two types of infections
associated with intravenous therapy. Phlebitis is the inflammation of the walls of the vein (Ho,
2012). Symptoms of phlebitis include eyrthema, pain, swelling and thrombosis (Ho, 2012). It
can lead to sepsis and bacterial endocarditits (Ho, 2012).Once the patient has been diagnosed
with phlebitis the intravenous catheter needs to be removed and a new one placed in a different
location to continue the therapy (Ho, 2012). Catheter –related blood stream infections are
associated with central venous access device maintence and insertion (Scales, 2011). Not only
are these infections dangerous to patient health but they also cost health care settings a great deal
of money.
Cost
Phlebitis and catheter-related blood stream infections are acquired infections from health
care. When infections are acquired in health care settings it is the responsibility of the setting to
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cover the cost. Blood stream infections and surgical site infections were responsible for 36% of
all hospital acquired infections in 2007 (DeBakey, 2009) According to the National Nosocomial
Infection Surveillance catheter-related blood stream infections represent the majority of blood
stream infections in the United States, resulting in 250,000 infections costing 6.25 billion dollars
annually (DeBakey, 2009) Catheter related blood stream infections and phlebitis put patients
health at high risk and cost our hospitals billions of dollars each year. In order to prevent these
infections we must first understand how patients get these infections.
Causes of Infection
There are many ways that intravenous devices or central venous access devices become
infected. Choosing the right location and using a sterile or aseptic technique during the procedure
can reduce infection. There is also some evidence about the timing of dressing and equipment
changes to decrease chances of infection. Also proper education and confidence of the staff
member performing the procedure is important. Making sure the hub of the device doesn’t
become contaminated by the hands of health care workers. Bacteria on the hub can work its way
into the blood stream. The most important aspect of reduce infections in intravenous therapy is
proper cleansing of the site of insertion. Ten million bacteria can exist on one square centimeter
of skin. Eighty percent of a person’s normal flora bacteria live in the top five layers of skin
(Scales, 2011). If the skin at the insertion site is not properly cleaned before the intravenous
device is inserted it can lead to infection.
Prevention
Education
Epic2 is a set of national evidenced-based guidelines developed by the Department of
Health to prevent infections associated with central venous access devices (Scales, 2011). These
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guidelines require that healthcare workers caring for patients with central venous access devices
be trained and assessed on infection prevention. Infection decreases when there are standards in
place for procedures. When aseptic technique is used and institutions have standards and
protocols in place for aseptic technique infection rates decrease. Also when inexperienced health
care providers perform the procedures there is evidence that infection rates increase. In
Michigan check-lists and standard protocols were used for central venous access device insertion
in intensive care units. This greatly decreased catheter related blood stream infections (Scales,
2011).
Location and Dressing Changes
Picking the right location for the right device can help lower infection along with
checking the site regularly. Central venous access devices may be placed in the subclavian vein,
jugular vein, and femoral vein. The subcalvian vein has been linked to lower rates of infection,
but higher rates of pneumothorax and hemorrhage. The femoral vein should be avoided if
possible, due to increased risk of infection and deep vein thrombosis. Subcalvian and jugular
veins are the best locations for central venous access devices. Once the catheter is in place it
should be inspected daily and before administering anything through it. A sterile transparent
dressing is ideal to put over top to keep an eye on the site. The dressing should be changed every
seven days or when it is no longer intact (Scales, 2011). If phlebitis, blockage, infiltration, or
infection is present the intravenous device should be discontinued and a new one inserted at a
different location (Ho, 2012).
Skin Asepsis
Properly cleaning the skin before the insertion of any intravenous device is extremely
important. When cleaning the skin before insertion it is important to keep in mind the type of
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solution being used, the motion of cleansing, and dry time. A study was done in 2008 comparing
the use of iodine in concentric circle versus the use of chlorhexidine gluconate in a back and
forth motion. The study found that the chlorhexidine gluconate decreased the rate of
contamination from 3.5% to 2.2%. In 2000 the Food and Drug Administration approved the use
of chlorhexidine gluconate for preoperative and preinjection skin preparation (DeBakey, 2009).
Since then chlorhexidine gluconate has gained popularity and multiple studies have proven its
effectiveness.
Conclusion
Intravenous therapy is used every day in the health care setting. They deliver life saving
and healing therapies. Infections in the intravenous device can cause as much harm as good.
Preventing these infections is of the utmost importance. Having educated and experienced staff
performing the procedure and care decreases the chances of infection. Along with standards to
how the insertion and maintence of intravenous device is made. Making sure the site is being
monitored and dressings change can also help decrease infection. The most evidence in
decreasing infection is the use of chlorhexidine gluconate in a back in forth scrubbing motion in
preparation of the procedure.
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References
DeBakey, Micheal E. (2009). Going around in circles: Is this the best practice for preparing
skin? Critical Care nursing Quarterly, 32(2), 94-98.
Doi:10.1097/CNQ.0b013e3181a27b86
Ho, K.., Cheung, D. (2012). Guidelines on timing in replacing peripheral intravenous
catheters. Journal of Clinical Nursing, 21(11/12), 1499-1506. doi:10.1111/j.13652702.2011.03974.x
Scales, Katie. (2009). Correct use of chlorhexidine in intravenous practice. Nursing Standard,
24(8), 41. Retrieved from http:/nursing-standard.co.uk
Scales, Katie. (2011). Reducing infection associated with central venous access devices.
Nursing Standard, 25(36), 49. Retrieved from http:/nursing-standard.co.uk