Biography
Q1: What does the Infusion Nurses Society (INS) recommend regarding the use and maintenance of needleless connectors and injection ports?
A1:
The care and maintenance of luer activated access devices (injection or access caps, needleless connectors) should follow the manufacturer's labeled use(s) and directions.
View More...Each organization will establish its own policies and procedures and practice guidelines according to the chosen device. The luer activated access device must be thoroughly disinfected with an approved antiseptic prior to each use, and the antiseptic allowed to dry thoroughly before the device is accessed. (Infusion Nursing Standards of Practice, 2006)
Q2: Is it accepted practice to connect the open end of an infusion set to a luer activated access site on the same infusion set?
A2:
Members of the INS Nursing Network state that although this is done, "looping" is
not best practice.
View More...Unless the end of the tubing is covered by a sterile device and the luer activated access site is thoroughly disinfected, the tubing does not remain sterile. If an infusion set is intended to be reconnected to a vascular access device, a sterile covering device (sterile end caps) should be applied to the end of the infusion set each time it is disconnected. The luer activated access site should be thoroughly disinfected before it is accessed again. (INS Newsline January/February 2010)
Q3: What is the recommended technique for disinfecting a luer activated access device?
A3:
Cleanse the luer activated access device thoroughly prior to each use with either 70% alcohol or povidone-iodine solution.
View More...Current best practice suggests using a twisting, turning, and scrubbing motion similar to that of juicing an orange for up to 30 seconds to ensure adequate friction. Allow the antiseptic solution to dry completely before the device is accessed. (Infusion Nursing: An Evidence-Based Approach, 2010).
Q4: Does the Infusion Nurses Society (INS) address practices to prevent catheter-associated bloodstream infections (CA-BSIs)?
A4:In addition to the textbook "Infusion Nursing: An Evidence-Based Approach" published in 2010, the INS' Infusion Nursing Standards of Practice offer several evidence-based practices to prevent CA-BSI.
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- Aseptic technique is to be used when changing add-on devices such as stopcocks, extension sets, and luer activated access devices.
- To prevent the entry of microorganisms into the vascular system, the luer activated access site of infusion and extension sets shall be aseptically cleansed prior to use.
- Any time a luer activated access device is removed, it should be discarded and a new sterile device attached.
To learn more on how to obtain your copy of the
Infusion Nursing Standards of Practice and Infusion Nursing: An Evidence-Based Approach, visit the Infusion Nurses Society Web site at
www.ins1.org.
References:
Infusion Nurses Society: Infusion nursing standards of practice,
JIN 62 (suppl 1S), 2006.
INS
Newsline January/February 2010
McGoldrick, M. Infection and Prevention Control in
Infusion Nursing: An Evidence-Based Approach. 3rd ed. St. Louis: Saunders; 2010. (12)214.
Biography
Q5: What are the new tools you are using to influence practice change?
A5: Improvisation, role-playing and participative discovery are new tools and strategies that can help hospitals improve adherence to best practices.
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These tools are perfect for use when trying to discover current practices and gaps and engage others in the process. Using this method to improve practice and prevent infections such as bloodstream infections associated with central lines provides an ideal learning opportunity. The way to implement change is not necessarily to tell people what to do, but to figure out and understand the processes involved and the barriers and the challenges to implementation. We are well past the point of arguing about best practices. We're now at the point of asking, "How do I implement this in my facility?" This involves making some very important changes in our approach and how we look at facilitating practice change.
Q6: Can you share more about one way to discover the reasons for not implementing best practices?
A6: Many times, healthcare personnel fail to do what is needed because there is something preventing them from doing it.
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It isn't a matter of a conscious decision not to utilize best practice. It is a matter of identifying the barriers and the obstacles. If, in a safe role playing process, you allow the participants to actually go through the motions and perform certain patient care processes, you can often times quickly identify issues and confront the barriers. This allows for group discovery of how to best approach those barriers, make corrections and build buy-in to the change.
Q7: Dr. Carrico, I enjoyed your webinar in November. Can you provide me with an example of how to use role-playing?
A7: We spent a lot of time going through specific situations in detail and asking the clinicians, "How do you currently handle this issue?" and "What would happen if you tried this approach?"
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This dialogue helped to bring out specific activities and interactions that had posed problems with adhering to best practices. We reviewed simple verbal and non-verbal techniques that help change the course of a practice or defuse a confrontational situation. The best part is having participants act out approaches that have been successful. Not every role-playing situation involves the negative. It is equally as effective when you can demonstrate what has worked and how situations were managed. This way, we share the positive as well as the negative. It helps everyone to see how they are perceived by others as sometimes we come across quite differently in our own minds and we don't realize the impact of influence we have on others.
Q8: Would you speak to how role-playing enables and empowers the staff?
A8: The focus toward elimination of healthcare-associated infection requires that everyone recognize their role in prevention.
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We talk a lot about enabling staff to do things like "stop the line" or to intervene when there is a breach in infection prevention, but often that's a whole lot easier said than done. Role-playing can help you learn how to manage a difficult situation while keeping all activities patient-centered. As we move through specific simulated situations, we learn what will work and how best to approach issues with different team members. We cannot allow a procedure to progress when the team recognizes a critical breach in patient safety that may result in patient harm. We have to figure out how to intervene? but we need to do that effectively and efficiently and in a manner that maintains mutual respect. All questions, all ideas and all comments need to be able to be discussed reasonably and respectfully.
A replay of the webcast: New Tools for Leading Change in Infection Prevention can be accessed by moving to the topic: Education\ Webcasts\ Practice Change Implementation Strategies, You will access a playback of the webcast done in November 2009.
Biography
Q9: Would you review some of the practice recommendations from the Joint Commission related to care of catheter hubs and injection ports?
A9: The Joint Commission has addressed disinfection of catheter hubs and injection ports in the 2010 National Patient Safety Goals (NPSG)
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NPSG 07.04.01 requires hospitals to implement evidence-based practices to prevent central line-associated bloodstream infections. In addition to addressing the disinfection of catheter hubs and injection ports before accessing the ports, the elements of performance also address the following components to reduce central line-associated bloodstream infections:
- Education of licensed independent practitioners, staff, and patients and families
- Monitoring compliance with evidence-based practices and evaluating effectiveness of prevention efforts
- Communication of infection data to leadership and clinicians
- Catheter checklist and standardized protocol for central venous catheter insertion
- Hand hygiene
- Evaluation of necessity of catheter
An excellent resource that provides evidence-based practices and strategies to prevent central line-associated bloodstream infections is available:
Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. To view the full article, access it through the topic headings
Education and Evidence-Based Practice and then click on Journal articles. The title will appear as
Marschall, J. et al. Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals, Infect Control and Hosp Epidemiol, 2008, 29:1, S22-S30.
The Joint Commission posts additional standards-related information to its website in a Frequently Asked Questions format. You may access this website from the following link:
http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/09_FAQs/default.htm
To enhance understanding of how the Standards and National Patient Safety Goals work together to help organizations reduce health care associated infections (HAIs), The Joint Commission has generously provided a link on the bsi website to their program regarding the three NPSGs pertaining to HAIs. You may access this through any of the topic headings:
Education, Clinical Practice, Evidence-Based Practice, Overcoming Barriers to Change and then clicking on Executive Summaries and Related Articles. The title will appear as below.
NPSG 7 Healthcare-Associated Infections from the Bedside to the C-Suite, Infection Control Education Series (August, 2009). Sponsored by the Joint Commission, Joint Commission Resources.
Click access the program to start viewing.
On August 31,2009, CareFusion Corporation completed its spinoff form CardinalHealth, Inc. References to Cardinal Health in the materials posted on this website prior to August 31, 2009, may relate to CareFusion and the business operated by CareFusion following the spinoff.
