Raising expectations

Catheter-related blood stream infections and life-threatening hospital acquired infections present a challenge for healthcare professionals across the world, but with the right strategies they are also the most preventable. Annie May reports.

Nurses and other health professionals need to move from infection control to infection prevention to minimise the number of healthcare-associated infections.
This was one of the key messages from UK IV therapy expert Andrew Jackson’s webcast, created specifically for nurses who manage IV lines and vascular access physicians, and broadcast last month.

“It is a simple change, but replacing that one word has changed my practice. It’s all about prevention, not control,” Jackson, who was the UK’s first IV nurse consultant, told the audience.In Australia for a one-week educational visit, Jackson was joined in the webcast by Tim Spencer, the clinical nurse consultant of the central venous access and parenteral nutrition service at the Liverpool Hospital. An estimated 200,000 healthcare-associated infections occur in Australian acute healthcare facilities each year. Around 12,000 of these are catheter-related blood stream infections. This results in unnecessary human and financial costs including patient morbidity and mortality, prolonged length of hospital stay and substantial costs to hospitals and the healthcare system.

Catheter-related bloodstream infections were once viewed as inevitable, but zero rates are now being reported in facilities in Australia and across the world.

“Cannulation is not a simple procedure. It can be potentially dangerous if not performed correctly,” Jackson said. “In my practice [a 600 bedded district general hospital] the expectation is that these problems don’t happen. Of course they sometimes do, but it’s not considered acceptable. It is not the norm. “Aspirations must be raised in terms of what can be achieved.”

Agreeing, Spencer said many infections could have been avoided if healthcare professionals had been more observant.

“There are oversights where patients are discharged and go home with a cannula. It is an accident, but it is a preventable accident. When you assess the patient prior to discharge, make sure all vascular access devices have been removed,” Spencer said.

Clinical audits were also important in infection prevention. “It’s every nurse’s responsibility to be able to do that clinical audit, because they are the eyes and ears of what’s happening with the patient. They can monitor these things a lot closer than anyone else.” It is also essential that nurses know how you can get an infection, said Jackson.

“If you know how an infection occurs you can find out how to prevent it. Bugs don’t just arrive to the patient, they have to be put there.”

Infection prevention can’t occur if health professionals don’t wash their hands and this remains to be a problem in some facilities, Jackson said.

On this he congratulated Australia on identifying hand washing as a drug error. Referring to an Australian study that put the nation’s drug error rate at 87 per cent, he said a similar UK study put its drug error rate at 50 per cent.

“The difference was that the Australian study included hand washing as part of the drug error criteria. It is important to identify who is following hand washing procedures and who isn’t. You have changed what a drug error is,” Jackson said.

Jackson used the webcast to encourage the use of the bundle of care process which is proving very successful in the UK. While this is happening in many Australian facilities, Spencer said the aim was to achieve standardisation and make practice changes across the state or country.

And for Jackson’s final piece of advice: start counting.

“You need to know your infection and error rate so you know that you are improving,” he said. n

The webcast can be viewed at http://vioca.st/Andrew_Jackson_Infection_Prevention_IV_Management_Educational_Webcast.