Tag Archives: Prevention

WHO publishes new Guidelines to prevent bloodstream infections from peripheral intravascular catheter use (9 May 2024)

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The World Health Organization (WHO) has published the first global guidance to prevent bloodstream infections (BSIs) resulting from the use of peripherally-inserted intravascular catheters. This article will describe the aseptic technique for peripheral intravenous catheter (PIVC) insertion that is validated by the Guidance Development Group (GDG). The link to the Guidance document will be provided at the end of this article.

Background Information:

Intravascular catheters fall broadly into two categories: those that are inserted into peripheral blood vessels (veins and arteries), and those that are inserted into central vessels.

Peripherally-inserted catheters are used far more commonly than other intravascular catheters and therefore, require special attention. In particular, peripheral intravenous catheters (PIVCs) are one of the most common invasive devices used in health care facilities, with up to 70% of all inpatients requiring a PIVC at some time during their in-hospital stay.

Poor practices in the insertion, maintenance, and removal of these catheters carry a high risk of introducing germs directly to the bloodstream, which can lead to serious conditions such as sepsis, and difficult-to-treat complications in major organs like the brain and kidneys. Soft tissue infections at the insertion site of the catheter can also occur.

Many bloodstream infections are caused by antibiotic resistant bacterial infections. It is estimated that bacterial antimicrobial resistance (AMR) was directly responsible for at least 1.27 million deaths and contributed to an additional 4.95 million deaths in 2019.

Key Messages:

The new Guidance document contains 14 good practice statements and 23 recommendations covering catheter insertion, maintenance, and removal.

Validated procedure for aseptic insertion of peripheral intravenous catheters (PIVCs):

  1. Prior to commencement of the procedure, clean the workspace where you intend to place the pack and materials for PIVC insertion and wipe with an appropriate disinfectant; then gather all appropriate materials.
  2. Perform appropriate hand hygiene before touching the patient (Moment 1).
  3. Position the patient for PIVC access to allow optimal visualization of the PIVC access site and ensure that the patient is comfortable. Inspect the PIVC access site to locate the vein.
  4. Perform appropriate hand hygiene (Moment 4 and Moment 2).
  5. Open the sterile pack(s) containing the required components for PIVC insertion in such a way that all contents are readily accessible, but taking care not to touch the internal sterile surfaces of the insertion pack. Pour the skin disinfectant solution (for example, 2% chlorhexidine gluconate plus 70% alcohol [ethanol or isopropyl]) into the sterile container in the pack. If using a pre-soaked swab, open the swab packet and drop it onto the sterile insertion pack zone without touching the swab.
  6. Open the PIVC packet and without touching the PIVC, drop it onto the sterile surface of the PIVC insertion pack zone.
  7. Apply the tourniquet*.
  8. Perform hand hygiene before performing the aseptic technique/procedure (Moment 2).
  9. If using gloves, then put on non-sterile gloves, being careful to not touch potentially
    contaminated surfaces such as the outside of the glove box or nearby surfaces.
  10. Thoroughly clean the intended insertion site with a skin disinfectant and allow to dry.
  11. Insert the PIVC without touching the insertion site with your fingers. If the insertion site is touched, it should be considered potentially contaminated and it will need to be disinfected again. If PIVC cannulation cannot be performed without touching the insertion site, then sterile gloves should be used to ensure that touching the site will not contaminate the insertion field.
  12. Release the tourniquet.
  13. Connect the PIVC to any required devices (for example, luer lock, injection “bung” or IV tubing/giving set) without touching any sterile components.
  14. Place a suitable sterile dressing over the PIVC to anchor it appropriately and ensure that the insertion site is correctly covered. Ideally, an occlusive, semipermeable, transparent PIVC dressing should be used as this will allow a ready daily visualization of the insertion site without removing the PIVC dressing.
  15. Dispose of the PIVC insertion pack waste according to local policy, place the PIVC insertion needle in a suitable sharps container (waste and sharps containers should ideally be within arm’s reach of performing the procedure) and clean the insertion trolley surface with an appropriate disinfectant.
  16. Remove gloves.
  17. Perform hand hygiene after the aseptic procedure and after touching the patient (Moment 3 and Moment 4).

*The tourniquet should ideally be disinfected before use, but this might be impractical; alternatively, a single-use tourniquet could be used, if available.

Useful Links:

Link to the related WHO news release:

https://www.who.int/news/item/09-05-2024-new-guidance-aims-to-reduce-bloodstream-infections-from-catheter-use

Link to the new guidance document:

https://iris.who.int/handle/10665/376722