CVAD infection prevention

Section Recommendation statement Grading of recommendations
44. Clinicians must adhere to the Five Moments of Hand Hygiene.
Hand hygiene policy
45. Clinicians are to evaluate the risk of body fluid exposure and cross contamination risk when caring for a patient with a CVAD. PPE, including goggles/face shield, gloves and gown/apron as per the NSW 2007 Infection prevention and control policy, should be worn accordingly. National Guidelines and NSW Policy
46. Aseptic non-touch technique must be used when attending to CVAD dressings, administration set changes and any intervention that involves accessing the CVAD (1-3). Grade A

The insertion of a CVAD may result in an infection which is a serious complication. A central line associated blood stream infection (CLABSI) is a bloodstream infection associated with a CVAD where the CVAD is considered to be the source of bacteria or microorganisms. These microorganisms can lead to serious illness and the infections require significant treatment, often resulting in an extended hospital stay. Many bundled insertion projects around the world have been undertaken in recent years to mitigate the risk of infection at the time of insertion (4, 5). CLABSI may also a consequence of post insertion care and maintenance. CLABSI may be documented on the Central Line Insertion Record available in NSW.

Hand hygiene

The NSW Health Hand Hygiene Policy (PD2010_058) states that all staff must perform hand hygiene as per the Five Moments for Hand Hygiene. Hand hygiene must occur before touching the patient; prior to a procedure; after a procedure or body fluid exposure risk; after touching a patient; after touching a patient’s surroundings. Hand hygiene can be performed using appropriate soap solutions and water or alcohol-based hand rub (ABHR). Soap and water must be used when hands are visibly soiled.

Before touching a patient, before a procedure, after procedure, after touching a patient, after touching a patient's surroundings

Based on the 'My 5 moments for Hand Hygiene', © World Health Organization 2009. All rights reserved.

Personal protective equipment

The Australian Guidelines for the Prevention and Control of Infection in Health Care and the NSW Infection Control Policy (PD2007_036) state that all procedures that generate or have the potential to generate secretions or excretions require that either a face shield or a mask with protective goggles be worn.

NSW Ministry of Health policies

Prevention of infection is an important aspect of any clinical practice guideline. Users are directed to the following policy directives covering infection control. Local policy must also be consulted.

  1. Infection Control Policy (PD2007_036)
  2. Infection Control Policy: Prevention & Management of Multi-resistant Organisms (MRO) (PD2007_84)
  3. Hand Hygiene Policy (PD2010_58)

Other relevant policies and standards

  1. Australian Guidelines for the Prevention and Control of Infection in Health Care
  2. Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of associated environments in healthcare facilities. ASA 4187:2003.

Grading of recommendations

Grade of recommendation Description
A Body of evidence can be trusted to guide evidence
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation/s but care should be taken in its application
D Body of evidence is weak and recommendation must be applied with caution
Consensus Consensus was set as a median of ≥ 7
Grades A–D are based on NHMRC grades (6)

References

  1. Care ACoSaQiH. Australian Guidelines for the Prevention and Control of Infection in Healthcare. In: Government A, editor. 2010.
  2. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, et al. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection. 2007;65 Suppl 1:S1-64. PubMed PMID: 17307562.
  3. Larwood KA, Anstey CM, Dunn SV. Managing central venous catheters: a prospective randomised trial of two methods. Australian Critical Care. 2000;13(2):44-50. PubMed PMID: 11235451.
  4. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU.[Erratum appears in N Engl J Med. 2007 Jun 21;356(25):2660]. New England Journal of Medicine. 2006;355(26):2725-32. PubMed PMID: 17192537.
  5. Burrell T, Mc Laws ML, Murgo M, Calabria E, Pantle AC, Herkes R. Aseptic insertion of central venous lines to reduce bacteraemia: The Central Line Associated Bacteraemia in NSW Intensive Care Units (CLAB ICU) Collaborative. MJA. 2011 6 June 2011;194(11):583-7.
  6. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.