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How to prevent the hospital cluster infection of PIVC-BSI?

How to prevent the hospital cluster infection of PIVC-BSI? Because it is difficult to prevent the colonization of microorganisms on the skin near the entrance of the catheter, nurses can only take various measures to reduce the probability of microorganisms multiplying.

The occurrence of infection is a common hospital adverse event that seriously threatens the life and health of patients. It usually occurs in departments with strong invasive operations, such as intensive care unit (ICU). Previous studies have focused more on blood infections associated with central venous catheters. Peripheral venous catheter-associated bloodstream infections (PIVC-BSI) have a lower risk of infection than other bloodstream infections associated with venous catheters.

However, PIVC puncture is the most common invasive procedure in clinical practice, and more than one billion patients worldwide receive PIVC puncture/indwelling every year. Due to the widespread popularity of PIVC, its absolute infection rate is close to that of other catheters. Once a bloodstream infection occurs, it will increase the patient’s discomfort, mortality, hospitalization time and costs. Therefore, PIVC-BSI has received more and more attention in recent years.

PIVC-BSI preliminary judgment

Due to the low incidence of PIVC-BSI in China, there are few reports and studies. For hospital cluster infections, the first consideration is the source of infection caused by insufficient air cleanliness, equipment contamination or improper operation. Due to widespread use, inconsistent coding, and lack of mandatory reporting of PIVC, the burden caused by peripheral venous catheter-related complications was underestimated and the cluster infection caused by PIVC was not considered in time.

In these cases, the patients experienced chills and body temperature higher than 38°C during PIVC indwelling, which was consistent with the clinical symptoms of catheter-related bloodstream infection. In addition, medical staff have gradually ruled out the possibility of other infections. Surgical heat refers to the reaction that occurs after the destruction of the surgical operation, the decomposition products of the tissue, and the absorption of local exudate and blood.

After the operation, the patient’s body temperature may rise slightly, and the range of change is 0.5 ℃ ~ 1 ℃, generally not more than 38.5 ℃. The time of chills in 8 patients was 3-12 days after surgery, and the body temperature was over 38.5℃. However, patients with surgical fever usually did not experience chills, so the factor of surgical fever can be ruled out. Eight patients have completed orthopedic surgery. Seven of them have implanted artificial joints.

Therefore, it is suspected to be caused by implants or contamination of the operating room. However, observe the surgical site wound without obvious signs of infection such as redness, swelling and exudation, and 7 cases The patient’s implants came from different batches of products. At the same time, the investigation found that other patients who used the same batch of products or used the same operating room had no signs of bloodstream infection, so the factor of implant or operating room contamination was ruled out .

On the second day of infection, investigators noticed that all patients had symptoms of infection shortly after the end of the intravenous infusion. The time from exposure to infection in patients with bloodstream infection is usually very short (0.5~2 days), and all patients have no other indwelling catheters except PIVC, so PIVC-BSI is suspected. The preserved peripheral venous indwelling needle and the eluate from the indwelling needle were subjected to bacterial culture and then determined to be PIVC-BSI.

Cause Analysis

Patients’ postoperative medications are all deployed by the intravenous drug allocation center. After screening more than 1,700 patients in other wards of the whole hospital, it was found that there were no patients with collective chills and fever. The patient’s fever in other wards can be reasonably explained, so it is considered to be caused by internal reasons in the ward. Burkholderia cepacia is usually isolated from natural soil, water, plants and animals. It is often found in contaminated water, pipes and instruments. It is an aerobic, non-fermented, gram-negative bacillus.

One of the common sources of nosocomial infections. Throughout the summer, the air humidity in the treatment preparation room fluctuates between 60% and 80%, which is suitable for the growth and reproduction of Burkholderia cephalosporium.

When the high temperature lasts for a long time and the air conditioning temperature of the treatment preparation room is set too low, once the door of the treatment preparation room is opened, the hot and cold air inside and outside the room will meet to produce condensed water, which causes the air humidity to increase, creating conditions for bacteria to multiply , It will also affect the dry storage of sterile items. The investigation found that the surface of the sterile items in the treatment preparation room was damp, and the storage cabinet for the infusion set had mold growth.

Since the items were replaced and cleaned before sampling, the culture failed to find the real source of infection. Nevertheless, the investigation speculated that the infusion equipment is more likely to be contaminated due to moisture. In addition, the department’s implementation of infection management is not strong enough, and the implementation of various infection prevention and control measures in this department should be monitored and inspected regularly. After environmental disinfection treatment, humidity control, and complete replacement of infusion equipment, no patients experienced concentrated fever again.

Preventive control measures

1. Environmental disposal measures

Strengthen the cleaning and disinfection of the environment every day. Use wet scrubbing to clean, mainly including floors, bed parts and surfaces. The floor is cleaned with an “N” shape, and the surface of the article is wiped with an “S” shape. When cleaning and disinfecting the parts of the hospital bed, the operation should be carried out in accordance with a unified procedure, which means that each hospital bed should be equipped with its own cleaning towel and cannot be mixed. The frequency of cleaning and disinfection is higher than the frequency of cleaning and disinfecting the surfaces with high frequency of contact with equipment control interface, storage cabinets, bed rails, door handles, etc.

Regulate the temperature and humidity of the treatment preparation room. Record the temperature and humidity of the treatment preparation room for each shift. Set the air conditioner temperature to 26°C. When the air humidity exceeds 60%, open the door for ventilation or use a dehumidifier to reduce the air humidity.

Replace contaminated items. When it is suspected that PIVC-BSI may be directly transmitted through damp and contaminated PIVC, all infusion-related items in the treatment preparation room should be replaced, including infusion sets, infusion needles and infusion patches.

2. Improve management

Strengthen the monitoring of the environment and patients. Nurses should inspect patients in the ward every day for signs of infection, monitor the temperature and humidity of the treatment preparation room, and whether the storage of sterile items is intact. The head nurse should check the implementation of monitoring, cleaning and disinfection every week.

Develop and implement standardized operating procedures. The hospital should formulate disinfection guidelines for treatment preparation rooms, treatment rooms and disposal rooms, formulate standard operating procedures for the use of dirt elevators, and manage and implement them in accordance with unified standardized operating procedures.

Update nursing emergency management plan. In order to increase the attention of all clinical nurses to PIVC-BSI, the intravenous treatment expert team should develop standardized emergency procedures to deal with infusion fever, especially when blood infections related to catheters are suspected.

3. Strengthen training

The medical staff of the hospital, especially clinical nurses, should be publicized and taught the “Management Regulations for Environmental Surface Cleaning and Disinfection of Medical Institutions” issued by the National Health Commission of the People’s Republic of China in 2016. Strengthen the training of nurses on PIVC-BSI identification and emergency response, and instruct logistics personnel on how to effectively clean and disinfect the ground and the surface of objects and deal with dirt.

Because it is difficult to prevent the colonization of microorganisms on the skin near the entrance of the catheter, nurses can only take various measures to reduce the probability of microorganisms multiplying. The principle of aseptic operation must be followed during the puncture process to prevent microorganisms from entering the blood through the hands of medical staff and contaminated infusion equipment. It is recommended to use a 70% isopropanol solution containing 2% chlorhexidine to disinfect the skin before puncture; in addition, it is also recommended to use a needleless connector to reduce the chance of contact with blood. When the dressing that fixes the catheter becomes loose or contaminated by blood or sweat, it is recommended to disinfect the skin and change the dressing in time.

How to prevent the hospital cluster infection of PIVC-BSI?