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< RETOUR

Invasive procedures: increased vigilance required

15/02/22

Healthcare-associated infections (HAI) affect hundreds of millions of people all over the world and pose a major issue in terms of patient safety. In modern healthcare facilities and in developed countries, 5 to 15% of patients contract one or more HAIs1. In intensive care units, the mortality rate associated with HAIs can reach 44%2. In France, the Surveillance et la Prévention des Infections Associées aux Dispositifs Invasifs3 [Monitoring and Prevention of Infections Associated with Invasive Devices] (SPIADI) is a national undertaking.

How can infectious risks be prevented and managed? What are the correct procedures to be observed?

Increased infectious risks

Vascular access, urinary drainage and assisted ventilation are essential to modern medicine. Most hospitalised patients will undergo one or more of these invasive procedures. However, the temporary insertion of a catheter, urethral catheter or endotracheal tube is associated with a significant infection risk.

Espinasse and allestime estimate that more than 60% of HAIs are associated with the insertion of a medical or surgical device4.

In France, the latest survey carried out by Santé Publique France (Public Health France) show that the risk of infection is higher in patients who have an invasive device, particularly those with a catheter.

Inserting a catheter and preventing HAIs: 7 steps to keep in mind!

How can we prevent infections associated with short peripheral venous catheters and subcutaneous catheters? Here is a short reminder of the steps to follow6 to prevent the influx of microorganisms and create aseptic conditions.

Step 1: wash your hands

  • With a hydroalcoholic solution following the 7 steps of hand washing7, for at least 30 seconds. Jewellery should not be worn and short, unvarnished nails are recommended. This hand hygiene process should be completed 3 times: before preparing the equipment, before putting on gloves and after gloves are removed.

Step 2: prepare the equipment before inserting the catheter

  • Use an extension to avoid handling the base. For a subcutaneous catheter, a small calibre catheter is recommended.

Step 3: skin preparation for inserting a catheter

  • If the patient’s skin is dirty, clean it using a mild soap. An alcoholic antiseptic is used to disinfect the area, using a sterile pad. Another pad should be used if a second pass is needed. Wait for the antiseptic to dry.

Step 4: second hand washing before putting on sterile gloves.

  • The catheter can be inserted safely.

Step 5: remove your gloves

  • Third hand washing using a hydroalcoholic solution.

Step 6: prevent infection associated with the catheter

  • At least one person per team should monitor the local area for the appearance of induration, pain, erythema. More generally, watch for the appearance of an unexplained fever.

Step 7: Carry out a daily assessment to ascertain whether the catheter is still necessary.

Did you know?

Peripheral venous catheter infections are serious and preventable8 in 2 out of 3 cases.

Sources

1 Organisation mondiale de la santé (OMS), Lutte contre les infections, http://www.emro.who.int/fr/surveillance-forecasting-response/infection-control/infection-control.html

2 OMS, Infections Associées aux Soins et Promotion de l’Hygiène des Mains, https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiT1YjAtdjzAhWvxYUKHWzCBhoQFnoECAsQAQ&url=https%3A%2F%2Fwww.who.int%2Fgpsc%2F5may%2Ftools%2Fslcyh_presentation_pour_coordinateur_fr.ppt&usg=AOvVaw2VjuvQcFzQuCdJjMbRXhA4

3 Preventioninfection.fr, Réseau de Prévention des Infections Associées aux Soins (RéPIAS), https://www.preventioninfection.fr/qui-sommes-nous/, consulté le 18 octobre 2021.

4 F. Espinasse et al., « Risques infectieux associés aux dispositifs médicaux invasifs », Revue Francophone des Laboratoires – novembre 2010 – n°426, https://www.em-consulte.com/ecomplementfile/BIO/emm316.pdf

5 C. Daniau et al., Infections associées aux soins en établissement de santé : résultats
de l’enquête nationale de prévalence 2017, 14 janvier 2020, http://www.cpias-ile-de-france.fr/surveillance/enp/2017/daniau-beh-enp-sept2020.pdf

6 RéPIAS_SPIADI, Lily. Prévenir les infections associées aux cathéters veineux périphériques courts et sous-cutanés, https://www.spiadi.fr/app/files/SPIADI%20-%20Guide%20Pratique%20Lily.396613297c57602ea5fff378e4afb7dc.pdf, mai
2021.

7 https://sf2h.net/wp-content/uploads/2019/05/HY_XXVII_SF2H_CATHETERS-2019.pdf

8 A. Gagneux-Brunon et al., “Vascular catheter-related infection claims to health insurance company: often preventable”, Clin Microbiol Infect, 2014 Dec;20(12):O1084-7. doi: 10.1111/1469-0691.12684.