Recommendations
78.

An aseptic techniquemm must be used for vascular access device catheter site care and when accessing the system. [new 2012]

Relative values of different outcomesThe GDG considered bacteraemia, phlebitis and MRSA and C. diff reduction as the most important outcomes.
Trade off between clinical benefits and harmsNone of the outcomes identified as important were reported in the literature. The aim of all aseptic techniques is to prevent infection. To date, there is no evidence (RCT or cohort) that one aseptic technique is more clinically or cost-effective than another.
Economic considerationsThe GDG considered the cost of staff time, training, equipment, and infections when making this recommendation. The GDG agreed that any increase in cost associated with an aseptic technique would likely be outweighed by the prevention of catheter-associated infections.
The GDG thought that the difference in staff time and resource use between different aseptic techniques is likely to be minimal. Therefore, the most effective technique will also certainly be the most cost-effective.
Quality of evidenceNo clinical or economic evidence was identified.
Other considerationsThe GDG considered that this recommendation relates to patient safety and that the consequence of not implementing it means that the risk of adverse events are so severe, that the use of the word ‘must’ is appropriate in line with the guidance from the NICE Guidelines Manual (2009).182
Minor changes to this recommendation have been made during this update based on GDG consensus. The term ‘vascular access device’ has been inserted to avoid confusion as urinary catheters are also discussed in the guideline. This addition ensures that this recommendation can be read as a standalone recommendation.
ANTT™ (www​.antt.org.uk) was also added to the footnote of the recommendation as a possible aseptic technique for VAD maintenance. It was the opinion of the GDG that standardisation of aseptic techniques would reduce confusion among healthcare workers and lead to better training about the principles of asepsis. The GDG considered that ANTT™ is widely used in acute and community settings and represents a possible framework for establishing aseptic guidance. The GDG felt that protocols for aseptic technique could be established in organisational policies to support this approach but did not feel that a separate recommendation was required.
See also recommendations regarding asepsis discussed in the Long term urinary catheters and Enteral feeding chapters.
mm

The GDG considered that Aseptic Non Touch Technique (ANTT™) is an example of an aseptic technique for vascular access device maintenance, which is widely used in acute and community settings and represents a possible framework for establishing standardised aseptic guidance.

From: 12, Vascular access devices

Cover of Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care
Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care: Partial Update of NICE Clinical Guideline 2.
NICE Clinical Guidelines, No. 139.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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