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Focus on reducing the risk of infections from medical devices; Dr Eleri Davies explains the "indelible" impact witnessing a patient develop an infection in hospital has had on her work THEPROFESSIONALS.

Byline: Eleri Davies

THE use of devices like urinary catheters and intravenous cannulas are often an important part of treatment for many patients.

A urinary catheter is a small tube, often inserted into a patient's bladder following an operation or during an illness.

Intravenous cannulas are inserted into the vein to allow intravenous medicines and fluids to be given.

Unfortunately, both devices carry a small risk of infection because they can allow bacteria into the body.

That's why the work being done by NHS Wales staff across health boards to improve the use of these devices, and reduce numbers being used, is so important.

It will ensure we are doing all we can to reduce the risk of infection to patients.

It has been introduced by 1,000 Lives Plus, the national programme, which is supporting organisations and individuals to deliver the highest quality and safest healthcare for the people of Wales.

I am fully behind this work, as I know from personal experience what can happen when a cannula is left in longer than necessary.

As a junior doctor, many years ago now, I admitted a patient in acute heart failure who had heart valve disease.

I knew I needed to give medication to treat the heart failure and that the best way of doing this was through an intravenous cannula.

I inserted the device and the patient was admitted to the coronary care unit to be stabilised and the patient improved.

At this point the patient was well enough to be transferred to a ward and no longer needed intravenous medications, so the cannula could possibly have come out.

However, either because the ward was busy or because it was felt it would be best to leave the cannula in place, in case further treatment was necessary, it was not removed and the patient developed an infection.

The infection spread rapidly from the cannula into the patient's blood and also infected the already damaged heart valves, which meant emergency heart valve replacement surgery was needed.

Thankfully, the patient survived the infection and the surgery, and was eventually discharged from hospital. The experience, however, left an indelible print on my mind and was a salutary lesson in the unintended harm that can result from medical devices, needed for treatment, but that can lead to problems if left in too long.

The incident sparked in me a fervent interest in infection control and I am wholeheartedly behind this new work to improve the way we deliver care.

By stopping, thinking and removing a device when appropriate, we really can help to save lives and avoid patients suffering unnecessary harm.

We know considerable work has already taken place across Wales and we are meeting staff this week to discuss the progress made and next steps to take.

Organisations have been implementing two new care bundles - a set of interventions that work better together than separately - to improve care and reduce infections.

Staff are also being encouraged to use a checklist each time for every patient to ensure the correct decision is made for them.

The work is already is showing signs of success with fewer devices being inserted and infections reducing.

There are always going to be times when the insertion of an urinary catheter or intravenous cannula is the best course of action for patients and, on occasions, complications from the use of medical devices may be unavoidable.

However, we must minimise the risks as much as possible.

This new focus will enable healthcare staff to stop and think if the device is really needed and if it is, will ensure maintenance is improved and it is removed as soon as it is no longer needed.

* Dr Eleri Davies is director of the Welsh Healthcare Associated Infections Programme and a member of the 1,000 Lives Plus Faculty
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Geographic Code:4EUUK
Date:Mar 26, 2012
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