Infection prevention
IP&C: current trends and future directions
Dawn Stott highlights the findings from Freedom of Information (FOI) requests, practitioner surveys, and focus groups, which provide an insight into current knowledge and awareness around the role of airway devices in infection risk. In this article, she discusses the potential for patient harm and how this can be mitigated.
Infection prevention has always been a cornerstone of healthcare practice, particularly in environments where vulnerable patients are exposed to potential pathogens. As healthcare evolves, so too must the strategies and tools used to prevent infections. This article provides an overview of current trends and future directions in infection prevention, with a focus on the challenges associated with securing airway devices using unlicensed products. By exploring insights from NHS Trusts’ Freedom of Information (FOI) requests, practitioner surveys, and focus groups, the author aims to highlight the importance of best practices in reducing healthcare-associated infections (HCAIs) and improving patient safety.
The role of airway devices in infection risk Airway devices such as endotracheal tubes and laryngeal masks are critical in many healthcare settings, particularly during surgery
and intensive care. However, these devices pose a significant risk for infection, particularly when secured using unlicensed products. These risks arise from a lack of standardisation and potential contamination, leading to HCAIs, including ventilator-associated pneumonia (VAP), which is one of the most common and serious complications in hospital settings. VAP is a lung infection that develops in people
who are on mechanical ventilation through an endotracheal or tracheostomy tube for more than 48 hours. It is a serious complication, often occurring in critically ill patients in the intensive care unit (ICU). VAP is typically caused by bacterial pathogens that colonise the upper respiratory tract and enter the lungs via the ventilator tube, leading to infection. This can be because of endotracheal
tube movement resulting from inadequate securement methods. In a retrospective study Suljevic, Asotic, Surkovic, Turan and Spahovic discussed the frequency of ventilator associated
pneumonias in patients in the ICU (Pub Med Aug 2020),4 Symptoms include fever, increased
Alternative solutions to tapes and ties, to secure airway devices, can help avoid the risk of transmission of healthcare-associated infections.
respiratory secretions, and decreased oxygen levels. VAP is associated with increased morbidity, extended hospital stays, and higher healthcare costs. Preventive strategies, such as excellent airway securement techniques, strict hand hygiene, elevating the head of the bed and routine oral care, are critical to reducing the incidence of VAP in healthcare settings. In a recent survey, the question was asked: Are you aware that the airway may migrate during an intervention, and that this could cause harm to the patient? The resulting responses to this question were that 95.7% of respondents were aware that the airway may migrate during the intervention and could cause serious harm to the patient, but they continued to use the same methods of securement. Despite clear guidelines for airway management, there are no guidelines or advice on best techniques for the securement of the airway device which include infection prevention suggestions. There is growing evidence that many healthcare facilities still rely on non- medical-grade products, such as tape, for securing airway devices. This practice not only compromises patient safety but also exposes healthcare providers to potential legal and ethical challenges. Using tape to secure an airway device poses some infection risks, primarily due to the potential accumulation of bacteria and moisture under the tape. This environment creates ideal conditions for bacterial growth, which can lead to skin irritation, breakdown, and secondary infections around the mouth and nose. Additionally, the tapes used may not be single use tapes and may have been kept in unhygienic environments i.e. scrub pockets, attached to a theatre trolley or may have been picked up from the floor!
December 2024 I
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Photo courtesy of Pentland Medical
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