HINT: Do I need to wear gloves when giving medications via a CVAD?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: Do I need to wear gloves when giving medications via a CVAD?
SITUATION:
This QuickHit! comes from a family caregiver who asked why we teach that they don’t need to wear gloves when giving medications via Central Venous Access Devices (CVADs) at home, but they see SickKids nurses doing it in hospital. The family caregiver also shared that their home care nurses sometimes do, and sometimes don’t wear gloves when performing this activity.
BACKGROUND:
In hospital, families will have observed nurses wearing gloves when accessing CVADs to give medications. This is to prevent bacteria from being transferred between different patients cared for by the same nurse. Within the community and at home, family caregivers and/or home care nurses may not need to wear gloves when giving medications via CVAD, unless they are seeing more than one patient a day. There are however many important practices that help to reduce the likelihood of CLABSI (Central Line Associated Bloodstream Infection) in the paediatric population, no matter where they are cared for – such as wearing gloves when indicated.
ASSESSMENT:
It is important to remember the rationale for why we are donning PersonalProtective Equipment (PPE)! The use of barrier techniques, such as wearing gloves, decreases the risk of transmission of microorganisms. Because all surfaces are capable of harbouring pathogens, protective techniques are to be used for all procedures/actions/situations where there is risk of exposure to the child.
Remember: The most important process in the prevention of pathogen transmission is effective hand hygiene. The use of alcohol based hand rubs is also acceptable, unless hands are wet or soiled.
Indications for hand hygiene include the “4 Moments of Hand Hygiene”:
Before any contact with the child or the child’s environment (protects the environment from harmful organisms carried on your hands).
Before any aseptic procedure (protects the child against harmful organisms, including the patient’s own organisms, entering his or her body).
After any body fluid exposure risk - even when gloves are worn (protects yourself from potential harmful organisms).
After any contact with the child or the child’s environment (protect yourself from potential harmful organisms).
Also consider hand hygiene at the following moments:
When hands are visibly soiled (use soap & water)
After personal body functions (such as using the toilet, sneezing, or blowing one’s nose)
Between activities performed on the same patient when hands may be contaminated
Before preparing, handling, serving, or eating food (applicable for patients or oneself)
RECOMMENDATION:
When giving medications via a CVAD recommendations to prevent CLABSI in home care practice include:
Proper hand hygiene
If caring for more than one patient/day, use gloves
Disinfect caps before accessing the line by:
using an appropriate antiseptic (70% alcohol solution has effective antimicrobial properties and a quick dry time)
scrubbing the hub for 15 seconds and drying for an additional 15 seconds
Use an Aseptic Non-Touch Technique (ANTT) which includes avoiding the touch of any key sites and parts
Click here for more information on ANTT practices
Also recommended as a routine best practice:
Bathe the child often (daily, if possible) with soap and water and change bed linens regularly (weekly at a minimum) to help clean the skin and prevent infection.
Inspect the CVAD site, document any changes and seek help if concerned about a potential site infection (such as redness, leaking or drainage at insertion site) or sepsis (signs include - common infection symptoms along with a fast heart rate, fast breathing, low blood pressure, pale or patchy skin, excessive sleepiness or disorientation)
Consider consulting Connected Care Live if you or the child/family are unsure or have questions about the care or assessment of a child’s CVAD,and- keep your gloves handy- in case you need them!
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