In 2006, as part of a wider drive towards the adoption of improved antiseptic techniques, King's College Hospital conducted a baseline review of infection control measures within its Bone Marrow Transplant (BMT) unit.
BMT patients are highly susceptible to infections, which can lead to increased length of stay for patients, increased (costly) use of antibiotics and detrimental effects on the transplantation.
King’s has a 14-bed BMT unit in which 90 per cent of patients have a central line that often requires flushing between 20-25 times per day for each patient.
The unit’s Infection Control team conducted an audit that identified potential risks with current practice. One such risk was unstandardised catheter maintenance, which could lead to line blockages/breaks that require catheter repair/re-siting. Such blockages also require the unit to transfer patients to x-ray/theatre for replacement lines or the insertion of temporary lines, resulting in delayed drug administration and increased infection risk.
Typically, saline flushing is used in a number of circumstances, such as post insertion of vascular access devices (VADs) – peripheral and central; access and checking patency of VADs, and pre and post flushing of IV medications and infusions. Three separate studies (Worthington, Calop and Trautmann) have demonstrated that approximately 8% of manually prepared flush syringes are contaminated prior to patient administration due to breaks in aseptic technique.1
King’s traditional method of drawing up saline involved the three-part syringe assembly, and extracting the saline from the container via a needle into the syringe. This process took, on average, 48 seconds. Devices were not labelled, leading to further potential risk of medication errors and avoidable wastage.
The unit team recognised that reducing line-associated complications and infections would lead to long-term savings. The team sourced BD Posiflush™ pre-filled syringes for flushing as a solution to help standardise flushing practice, promote asepsis and improve catheter care.
BD Posiflush™ was trialled between May and July 2006, with hospital ward staff receiving training prior to and during the introduction of the device.
BD Posiflush™ is a pre-filled, ready-to-use device that can be assembled in just eight seconds compared to the previous 48 seconds. Its label includes batch identification, for improved tracking.
The BD Posiflush™ zero reflux design means that no blood reflux is created in the line, thereby optimising flushing.
BD Posiflush™ was introduced alongside other infection control initiatives including adoption of aseptic-non-touch-technique, hand hygiene and personal protection equipment re-launch, increased screening levels for VRE (Vancomycin resistant Enterococci) & MRSA (Methicillin-resistant Staphylococcus aureaus) and use of patient-only equipment and IV trays.
Since the introduction of BD Posiflush™, King’s has seen a significant reduction in line blockages and replacements. The hospital could see savings of approximately £75,000 in one year from the resulting reduction in replacement lines and IV antibiotic use.
Infection rates have reduced considerably since the introduction of BD Posiflush™ and other antiseptic improvement measures. A year after the introduction catheter tip positive culture rates reduced by over 50 per cent.
Adoption of BD Posiflush™ within King’s BMT unit is now complete, and the Infection Control team is promoting take-up of BD Posiflush™ within other departments at King’s, including A&E.
King’s College Hospital staff appraisal of BD Posiflush™
"Generally, it feels safer using this device and it speeds up the process dramatically."
"Neat and compact and ready to use."
About King’s College Hospital
King’s College Hospital NHS Foundation Trust is one of London's largest and busiest teaching hospitals, with a unique profile of strong local services and a focused set of specialist services.
This includes providing specialist services to patients across a wide catchment, and the hospital is recognised nationally and internationally for its work in liver disease and transplantation, neurosciences, cardiac and haemato-oncology.
1. Worthington T, Tebbs S, Moss H, Bevan V, Kilburn J, Elliott TSJ. Are contaminated flush solutions an overlooked source for catheter-related sepsis? The Hospital Infection Society 2001, Letters to the editor
Calop J, Bosson JL, Croizé J, Laurent PE. Maintenance of peripheral and central intravenous infusion devices by 0.9% sodium chloride with or without heparin as a potential source of catheter microbial contamination. J. Hosp. Infection 2000;46:161-162
Trautmann M, Zauser B, Wiedeck H, Buttenschon K, Marre R. Bacterial colonisation and endotoxin of intravenous infusion fluids. Journal of Hospital Infection (1997) 37, 225-236