Infection control

Standard

All infusion related procedures require the use of aseptic technique, observation of standard precautions and product sterility. Thorough hand-washing techniques must be employed before and after clinical procedures (DH, 2005b; Rowley & Laird 2006; Pratt et al., 2007).

Sterile gloves and maximal sterile barrier precautions must be used when performing infusion procedures such as insertion of central venous access devices (Pratt et al., 2007).

All disposable blood-contaminated and/or sharp items including, but not limited to, needles or stylets and surgical blades must be disposed of in non-permeable, puncture-resistant, tamper-proof containers which comply with UN 3921 and BS7320 standards, and should be located at a suitable and safe level in places which are not accessible to the public (HSE, 2002; IPS, 2003).

Non-disposable equipment such as surgical instruments requiring re-sterilisation should be handled according to manufacturers guidelines for sterilisation of items posing a hazard. However, disposable equipment should be used wherever possible.

All products requiring disposal must be managed in inline with HTM07-01 and local policy. Morbidity and mortality rates associated with catheter-related infections should be reviewed, evaluated and reported on a regular monitored, reviewed basis.

A quality assurance and performance improvement programme incorporating infection control practices should be implemented to minimise potential for development of health care associated infection and to provide corrective action, when necessary (DH, 2005b).

Guidance

The elements of, and protocol for, aseptic technique should be established in
organisational policies and procedures (NICE, 2003; RCN, 2005a; Hart, 2008a).

A protocol for ascertaining product integrity and sterility should be established in

organisational policies and procedures.

Practitioners performing procedures that result in the generation of droplets or

splashing of blood and/or body fluids should employ appropriate personal protective equipment including wellfitting gloves, mask, gown, protective eyewear and drapes (IPS, 2003; Pratt et al., 2007).

Regulation sharps containers should be placed at multiple convenient and safe locations,
should be easily accessible and, when filled to the fill line, should be sealed shut and labelled with the patients name/ward/clinic and dates. They should then be disposed of by designated personnel (Hanrahan and Reutter, 1997; Health Service Advisory Committee, 1999).

 Ideally, all needles should have a safety device, with engineered sharps injury
protection, to minimise the potentially serious consequences of exposure to bloodborne pathogens and the potential for permanent and disabling injury (UK Health Departments, 1998). Risk assessments should be undertaken, and the use of these devices considered in line with local policies.

Performance improvement measures, including site rotation and administration set

changes, should be implemented in accordance with the standards incorporated in this document.

Infection statistics should be documented and retained by each organisation (DH,

2005b).

A robust system for learning from incidents, such as infection, should be in place.