Tuesday, 3 April 2012
A new campaign to improve the quality and safety of patient care through better use of urinary catheters and intravenous cannulas and reduce the number being used in patient care has been launched by 1000 Lives Plus.
Patients who have catheters and cannulas are at risk of infection if they aren’t used correctly. Healthcare staff across Wales will be asked to S.T.O.P. and assess whether the patient they are caring for needs a device and if one is in place to question whether it’s still needed or could be removed.
S.T.O.P. prompts staff to Stop and ask is the device really needed?
It encourages them to Think and give the necessary attention to detail, to focus on Options considering if there are alternatives, and Prevent healthcare associated infections by ensuring the use and maintenance is as safe as possible.
S.T.O.P. is a key area of work for 1000 Lives Plus, the national programme supporting organisations and individuals to deliver the highest quality and safest healthcare for the people of Wales.
Jan Davies, 1000 Lives Plus Director, said, “There are always going to be times when the insertion of an catheter or cannula is the best course of action for patients. They can be an important part of treatment, but they can sometimes be used when they aren’t needed and can cause complications if left in for too long.
“By reducing the use of these devices and improving how they are maintained when they are needed, we can ensure we are doing all we can to reduce the risk of infection to the patient.
“By stopping, thinking and considering other options, we really can help to reduce infections and avoid patients suffering unnecessary harm.”
A catheter is a small tube often inserted into a patient’s bladder to relieve them of urine following an operation or during an illness. Cannulas are inserted into the vein to allow intravenous medicines and fluids to be given.
Both devices perform an important role, but carry a risk of infection which can result in complications for the patient and a prolonged stay in hospital.
Urinary tract infections are one of the most common causes of healthcare associated infections in Wales and the use of catheters increase their risk.
Cannulas can allow bacteria directly into the bloodstream although the incidence of infections is low.
S.T.O.P. will ask staff to consider firstly if the device is needed. If the answer is yes, then it must only be inserted by trained personnel and fastidious care taken each and every time to diminish the risk of infection.
The campaign will be supported by posters distributed across health organisations to raise awareness amongst staff and feature catheter and cannula characters alongside a large STOP sign, with the question ‘Does your patient need us?’
The S.T.O.P. campaign builds on the good work already in place across Wales to reduce healthcare associated infections in these areas.
Organisations are implementing two new care bundles -a set of interventions that work better together than separately – to improve care and reduce infections.
The insertion bundle includes ensuring hand hygiene is excellent, the skin has anti-septic applied to destroy germs and the device is inserted where it can be easily seen.
The maintenance bundle ensures staff review whether the device is still a necessity on a daily basis and remove it as soon as the patient’s clinical condition allows.
Staff will also be encouraged to use a checklist each time for every patient to ensure the correct decision is made for them.
Dr Eleri Davies, director of healthcare associated infections in Public Health Wales, said, “This new focus will enable healthcare staff to stop and think if the device is really needed.
“The message is simple and clear, yet it will make a real difference to the quality and safety of care delivered to the patient.
“Organisations are committed to winning the battle against healthcare associated infections and the S.T.O.P. campaign is supporting them to achieve this aim.”
Medical devices facts
- Urinary tract infections are the third commonest healthcare-associated infection in Wales and account for 16% of all healthcare associated infections.
- Audits have shown that up to 7.3% of patients with a PVC have had an infection as a result.
- Research shows that a using a very simple ‘Stop’ order can reduce catheter-associated urinary tract infections by over 50%.
- Within the 2006 prevalence survey, it was possible to calculate the device usage within the acute sector for Wales:
- 16% of patients had an urinary catheter in situ
- 37% of patients had a peripheral vascular cannula in situ.
Case Study: Royal Glamorgan Hospital, Llantrisant
Work to reduce the use of catheters and cannulas, and to remove them as soon as the patient no longer needs it, is already making a difference in a ward at the Royal Glamorgan Hospital, Llantrisant.
Since the introduction of the two new care bundles for insertion and maintenance, there has been a reduction in urinary tract infections and zero cannula related infections.
Bethan Cradle, Senior Infection Prevention and Control Nurse, said, “By introducing the care bundles and standardising care we are reducing and minimising the risk of infections.
“Staff have done really well and are starting to question do these invasive devices need to be used in the first place, and if they do, we need to make sure they are inserted and managed correctly to reduce risks.
“It has been a lot of work but it’s worth it when we see the results we are having.”
The work was piloted on the ward and is about to spread to the accident and emergency department and operating theatres within the hospital.
Ward nurse Melanie Watts said, “I don’t think we were so aware before of the risk of infections. This has introduced the importance of checking what we are doing and patients are benefiting because there are reduced infections.”
Case Study: Velindre Cancer Centre, Cardiff
More than 21,000 cannulas are inserted into patients each year in Velindre Cancer Centre so the 1000 Lives Plus work to improve their use and maintenance is vitally important.
Staff have implemented a number of strategies to reduce the risk of infections including introducing the insertion sticker and the PVC insertion pack containing the cannula and an alcohol-based liquid which prepares the patient’s skin to reduce infection. Maintenance bundles and standardisation of care across the centre is being implemented through staff training. At the same time this skin disinfectant has also been introduced for taking blood culture samples.
Gail Lusardi, Senior Infection Control Nurse, said, “Patients with cancer have weaker immune systems and at greater risk of infection so this work is vitally important”.
“We are using the care bundles and checking on a regular basis if a patient has signs or symptoms of infection in those with IV lines. As well as improving standardised care we are hoping to see a reduction in blood stream infections through the introduction of the insertion pack and use the skin disinfectant.”
Source: 1000 Lives Plus