Suctioning an adult ICU patient: Infection prevention and work health and safety

Recommendations for practice

Section

Recommendation

Grade

22.

Standard precautions require the use of personal protective equipment (PPE) to prevent contamination and mucosal or conjunctival splash injuries, and is mandatory while suctioning a patient. This must include goggles and mask or face shield/gloves and gown/apron as per NSW 2007 Infection Control Policy.

PD 2007_037 page 7

23.

Clinicians must adhere to the Five Moments of Hand Hygiene.

PD2010_058

24.

When using OSS technique an aseptic non-touch technique must be used.

Consensus

25.

Clinicians should perform a risk assessment for specific droplet and airborne precautions prior to suction.

Consensus

The evidence review for these recommendations was current to December 2012. Clinicians are advised to check the literature as research may have been published that change these recommendations.

Hand hygiene

The NSW Health Hand Hygiene Policy (PD2010_058) states that all staff must perform hand hygiene as per the 5 Moments for Hand Hygiene. Hand hygiene must occur on entering the patient bed area; prior to donning gloves to perform the suctioning procedure; on completion of the suctioning procedure; following glove removal and on leaving the patient bed area.

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.

Health policies

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_084)
  3. Hand Hygiene Policy (PD2010_058)

Other relevant policies and standards

  1. NHMRC. Australian Guidelines for the Prevention and Control of Infection in Health Care

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 worn with protective goggles be worn.

Therefore, the use of PPE to prevent mucosal or conjunctival splash injury is mandatory while suctioning the patient (both open and closed suction). This must include mask and goggles or face shield; gloves and gown/apron.

Suctioning of the artificial airway is to be completed using a clean technique for closed system suction and aseptic non-touch technique for (1) for open suction to minimise the potential for introduction of exogenous organisms into the respiratory tract of the critically ill patient. This is consistently supported by an SR (2) and an LR (3).

Recommended personal protective equipment for closed and open suctions systems

EquipmentClosed system suctioningOpen suctioning

Mask/goggles or face shield

Yes

Yes

Gown/apron

Yes

Yes

Gloves

Non – Sterile

Sterile

Suction catheter

Closed system catheter changed as per manufactures’ recommendations

Sterile suction catheter

Discarded post procedure

Field

Clean

Aseptic

Workplace health and safety

Prevention of work injury is an important aspect of any clinical practice guideline. Users are directed to the following policy directives covering work health and safety. Local policy must also be consulted.

NSW Work Health and Safety Act 2011

The NSW Work Health and Safety Act 2011 states that organisations must eliminate risks to the health and safety of workers where at all possible. When it is not possible to eliminate risks, the risk must be minimised as far as reasonably practicable. Organisations must provide appropriate PPE for use by staff. Staff have a responsibility to use that PPE according to policy.

The worker has an obligation under the NSW Work Health and Safety Act 2011 to;

  1. take all reasonable care for their own safety
  2. take care that their acts or omissions do not adversely affect the health and safety of other persons
  3. comply with any reasonable instruction they are given.

Grading of recommendation taxonomy

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 (4)

References

  1. ANTT. Available from: www.antt.org.uk.
  2. (AARC) AAfRC. AARC Clinical Practice Guidelines.  Endotracheal suctioning of mechanically ventilated patients with artificial airways. Respiratory Care. 2010;Jun; 55(6):758-64.
  3. Pederson CM, Rosendahl-Nielsen M, Hjermind J, Egerod I. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive and Critical Care Nursing. 2009;25:21-30.
  4. NHMRC. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines:PILOT PROGRAM 2005 - 2007. Australian Government; 2005.

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.