Action 3.10

The health service organisation has processes for the appropriate use and management of invasive medical devices that are consistent with the current edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare

Intent

Infections are minimised by the appropriate selection, safe insertion and maintenance, and timely removal of invasive medical devices.

Reflective question

How does the health service organisation ensure that the workforce selects, inserts, maintains and removes invasive devices safely?

Key tasks

  • Review the organisation’s compliance with relevant regulations, guidelines and state or territory requirements covering invasive medical devices
  • Review, develop or implement processes to cover introduction, use, management and removal of invasive medical devices used in the organisation.

Strategies for improvement

Hospitals

As part of the organisational risk assessment, determine:

  • Which invasive medical devices are used in the health service organisation
  • Where they are used
  • Which clinicians are using them
  • Escalation pathways to manage difficult insertion of invasive devices
  • Whether clinicians have been trained and assessed in appropriate selection, management and removal of the invasive medical devices they use
  • Consistency with the current edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare112
  • Compliance with relevant regulations, guidelines and state or territory requirements covering invasive medical devices.

Assess risks relating to indications for use, insertion and management of invasive medical devices in clinical and procedural areas, such as:

  • Medical and surgical inpatient areas
  • Interventional radiology
  • Emergency departments
  • Anaesthetic departments
  • Operating theatres and recovery
  • Special care units, including intensive care units, paediatric intensive care units and high-dependency units
  • Outpatient clinics.

Develop or review policies, procedures and protocols relating to the choice, insertion, maintenance and removal of invasive medical devices to cover:

  • Product selection and evaluation, including cost, cost-effectiveness and patient preferences
  • Supply and procurement
  • Introduction into the organisation
  • Education, training and competency assessments required before use
  • Any requirements for reassessment of competence
  • Strategies for individual inserters and departments to track their own complication rates
  • Scope of use
  • Reuse
  • Disposal
  • Storage
  • Transportation from storage to place of use, including
    • maintaining integrity and sterility
    • transport safety and time frames
    • temperature and moisture control
    • disposal considerations
  • Fault management
  • Recall
  • Evaluation of devices
  • Documentation in the patient’s healthcare record of time frames and reasons for insertion, management and removal of invasive medical devices, and patient assessment (including feedback and actions taken).

Identify the risks associated with the use and maintenance of invasive medical devices. This could include documenting:

  • Criteria for insertion, and selection of the best device for patient indications and purpose
  • Indications for the device to be left in place once inserted
  • Assessment of aseptic technique used at insertion and for maintenance activities
  • Use of evidence-based safety engineered technology
  • Evaluation of how clinicians choose the most appropriate device
  • Physical environment issues that affect insertion and maintenance of devices
  • Patient monitoring activities to identify infections relating to invasive medical devices
  • Use of the organisation’s incident reporting process
  • Review of incident reports relating to invasive medical devices for appropriateness, infection, referral, inconsistency or noncompliance with organisational policy, equipment failure and other adverse events
  • Patient engagement and education about use and maintenance of invasive medical devices
  • Indications for removal, evidence-based removal procedure and post-removal assessment of possible complications (for example, air emboli, bleeding from removal site).
Day Procedure Services

As part of the organisational risk assessment, determine:

  • Which invasive medical devices are used in the health service organisation
  • Where they are used
  • Which clinicians are using them
  • Escalation pathways to manage difficult insertion of invasive devices
  • Whether clinicians have been trained and assessed in appropriate selection, management and removal of the invasive medical devices they use
  • Consistency with the current edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare1
  • Compliance with relevant regulations, guidelines and state or territory requirements covering invasive medical devices.

Assess risks relating to indications for use, insertion and management of invasive medical devices in clinical and procedural areas, such as:

  • Admission areas
  • Interventional radiology
  • Anaesthetics
  • Operating theatres and procedure rooms
  • Recovery.

Develop or review policies, procedures and protocols relating to the choice, insertion, maintenance and removal of invasive medical devices to cover:

  • Product selection and evaluation, including cost, cost-effectiveness and patient preferences
  • Supply and procurement
  • Introduction into the organisation
  • Education, training and competency assessments required before use
  • Any requirements for reassessment of competence
  • Strategies for individual inserters and departments to track their own complication rates
  • Scope of use
  • Reuse
  • Disposal
  • Storage
  • Transportation from storage to place of use, including
    • maintaining integrity and sterility
    • transport safety and time frames
    • temperature and moisture control
    • disposal considerations
  • Fault management
  • Recall
  • Evaluation of devices
  • Documentation in the patient’s healthcare record of time frames and reasons for insertion, management and removal of invasive medical devices, and patient assessment (including feedback and actions taken).

Identify the risks associated with the use and maintenance of invasive medical devices. This could include documenting:

  • Criteria for insertion, and selection of the best device for patient indications and purpose
  • Indications for the device to be left in place once inserted
  • Assessment of aseptic technique used at insertion and for maintenance activities
  • Use of evidence-based safety engineered technology
  • Evaluation of how clinicians choose the most appropriate device
  • Physical environment issues that affect insertion and maintenance of devices
  • Patient monitoring activities to identify infections relating to invasive medical devices
  • Use of the organisation’s incident reporting process
  • Review of incident reports relating to invasive medical devices for appropriateness, infection, referral, inconsistency or noncompliance with organisational policy, equipment failure and other adverse events
  • Patient engagement and education about use and maintenance of invasive medical devices
  • Indication for removal, evidence-based removal procedure and post-removal assessment of possible complications (for example, air emboli, bleeding from removal site).

Examples of evidence

Select only examples currently in use:

  • Policy documents about the selection, insertion, maintenance and removal of invasive medical devices
  • Committee and meeting records in which use of invasive medical devices was discussed
  • Review of infection surveillance data about invasive medical devices
  • Actions taken to manage identified risks with the selection, insertion, maintenance and removal of invasive medical devices
  • List of invasive medical devices in use in the health service organisation and where they are used
  • Audit results of workforce compliance with processes for the selection, insertion, maintenance and removal of invasive medical devices.
MPS & Small Hospitals

MPSs and small hospitals should:

  • Review the organisation’s use of invasive medical devices
  • Review the organisation’s compliance with relevant regulations, guidelines and state or territory requirements covering invasive medical devices
  • Review, develop or implement processes to manage introduction, use, management and removal of invasive medical devices used in the organisation.

Organisations that use invasive medical devices should assess the risks relating to the use and maintenance of these devices. This could include:

  • Criteria for insertion, and selection of the best device for patient indications and purpose
  • Indications for the device to be left in place once inserted
  • Assessment of aseptic technique used at insertion and for maintenance activities
  • Use of evidence-based safety-engineered technology
  • Evaluation of how clinicians choose the most appropriate device
  • Physical environment issues that affect insertion and maintenance of devices
  • Patient monitoring activities to identify infections relating to invasive medical devices
  • Use of the organisation’s incident reporting process
  • Review of incident reports relating to invasive medical devices for appropriateness, infection, referral, inconsistency or noncompliance with organisational policy, equipment failure and other adverse events
  • Patient engagement and education about use and maintenance of invasive medical devices
  • Indication for removal, evidence-based removal procedure and post-removal assessment of possible complications (for example, air emboli, bleeding from removal site).
Last updated 2nd July, 2018 at 10:57pm
BACK TO TOP
References

National Health and Medical Research Council. Australian guidelines for the prevention and control of infection in healthcare. Canberra: NHMRC; 2010 (accessed Sep 2017).