Many clinicians know all too well that healthcare-associated infections (HAI) remain the primary cause of preventable death among hospitalized patients.
From maintaining normothermia and decolonizing nasal airways, to ensuring sterility of medical instruments and effective patient skin preps, the perioperative team focuses on a whole host of different practices to help curb surgical site infections (SSIs).
Yet, it’s important to remember that SSIs aren’t the only type of infections the perioperative team needs to worry about. Other common HAI can occur during the patient’s surgical journey that could impact their quality of care and surgical outcome.
For example, bloodstream infections (BSI) stemming from central or peripheral intravenous catheters can be the result of poor protocol compliance during placement or improper ongoing catheter maintenance while the patient is in the care of the perioperative team. This means a greater effort needs to be made to reduce the risk of HAI more holistically in the OR.
Every IV catheter poses an infection risk. Achieving successful infection prevention in the patient’s perioperative journey must include close attention to proper PIV insertion and diligent maintenance before removal.
The Peripheral Line
Peripheral intravenous catheters (PIV) are the most common vascular access procedure performed in medicine with more than 200 million patients receiving a peripheral line each year. Despite the high frequency, this routine step in the perioperative journey can often be overlooked as a potential infection risk.
Each PIV placed represents a potential entry site for BSI or for dislodgement, putting the patient’s safety at risk.
Peripheral line-associated bloodstream infections (PLABSI) and IV dislodgement can largely be prevented using a three-pronged approach: educating and developing highly trained staff on the importance of proper PIV insertion and maintenance, implementing evidence-based technology, and strictly following industry guidelines and best practices for placement and maintenance of each IV access and insertion site.
Barriers To PLABSI Prevention
A recent survey uncovered key challenges that nurses and infection preventionists (IP) throughout the care continuum face in their fight to reduce HAI in their facilities. The survey, Human Factors and the Future of Infection Prevention, found there are a number of barriers that impact successful infection prevention, including a lack of adopting new technology and processes (51 percent), lack of senior leadership support (51 percent) and poor protocol compliance (50 percent).
The survey also uncovered that only 60 percent of IP surveyed are familiar with their facility’s PLABSI prevention protocols and procedures, yet 56 percent of all respondents believe that PLABSI poses a real threat to patient safety.
Although these findings are alarming, they are not surprising. Health systems are not required to report PLABSIs even though, according to the Infusion Nurses Society (INS), 90 percent of inpatients require an IV to administer vital medications and fluids at some point during their care.
Clearly, more education on the importance of PIV care is needed. And on the bright side, educating and training staff on the use of standardized maintenance bundles has proven to reduce infections and promote patient safety.
(Image credit: 3M)
A Bundled Approach
Whether institutions view peripheral lines as harmless or staff are suffering from ‘bundle fatigue,’ most health systems do not have a bundled maintenance approach for PIV in place. However, there are proven technologies and practices that make it easier for clinicians to protect both PIV intraluminal and extraluminal access points at every point in the patient’s journey.
A team of researchers at Mercy Hospital in St. Louis, MO set out to see if implementing a PIV catheter maintenance bundle could reduce the occurrence of PLABSI at their facility.
The bundle’s components featured the use of disinfecting caps for needleless connectors and disinfecting caps for male luers, and also consisted of assessing and removing PIV catheters at the first sign of phlebitis and monitoring and changing the dressing if blood was present.
The facility used passive disinfecting caps that easily twist on to a variety of needleless connectors, to eliminate the need to manually scrub-the-hub. The caps used contain 70 percent isopropyl alcohol solution that disinfects in one minute and acts as a physical barrier to contamination for up to seven days, if not removed.
Additionally, the disinfecting caps improved compliance and acted as a visual cue that staff were following disinfecting procedures.
While this study was not conducted specifically in a surgical unit, the findings are applicable. The results of the full study, “A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters,” recently published in The Journal of the Association of Vascular Access, resulted in a compliance rate of 89 percent and the PIV maintenance bundle successfully decreased PLABSIs from 0.57 to 0.11 per 1000 patient days (p < 0.001), an astounding 81 percent reduction.
Safe PIV Securement
According to findings from a survey conducted by respected vascular access educator Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC, accidental dislodgement of PIV catheters is far more common than previously recognized. Results, reported in a poster at the Association for Vascular Access (AVA) Annual Meeting last fall, found nearly all 1,567 respondents reported having seen accidental dislodgement occur in one of their patients. And, 65 percent of the clinicians surveyed reported that inadequate securement of IV catheter tape is the root cause of accidental PIV removal.
Utilizing proven technology in alignment with best practice protocols can lead to successful prevention of dislodgement. Transparent IV securement dressings with CHG have been proven to reduce infections and minimize catheter movement. Antimicrobial dressings that integrate CHG transparently throughout the adhesive have been confirmed to sustain the suppression of regrowth of skin flora on prepped skin for up to 7 days.
These transparent dressings can also provide continuous visibility which enables early detection of complications at the insertion site and the catheter remains secure with technology designed to reduce edge lift, minimizing the chance of movement or dislodgement.
For education resources on making PIVs a central part of your infection risk reduction program, go to 3M.com/PIVcare.
Pat Parks, MD, PhD is the medical director for 3M Medical Solutions Division. He is also an Adjunct Associate Professor in the Department of Experimental and Clinical Pharmacology at the University of Minnesota. His passion and responsibilities include research and technologies related to catheter related bloodstream infections and wound healing.
A version of this article appears in the September/October 2018 issue of Surgical Products.
