Preventing Peripheral Intravenous Line Infections: Recommendations for Healthcare Facilities

2009 ◽  
Vol 14 (4) ◽  
pp. 187-190 ◽  
Author(s):  
Nancy Moureau
Keyword(s):  
United States ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Line ◽  
Intravenous Catheter ◽  
Central Lines ◽  
Healthcare Facilities ◽  
Peripheral Intravenous Catheter ◽  
Intravascular Devices

Intravascular catheters are indispensable tools in acute care, but with the benefits come the risk of local or systemic Healthcare Acquired Infections (HAIs). In fact, more than 250,000–500,000 intravascular-related bloodstream infections occur in the United States each year with resulting mortality rates of 12%–25%. (Maki, Kluger & Crnich, 2006; CDC, 2002). While bloodstream infections related to the use of peripheral lines may not occur as often as they do with central lines, they do occur. Although most studies focus on central catheter-related bloodstream infections due to their greater documented prevalence and severity, some studies have evaluated the prevalence of peripheral intravenous catheter-associated bloodstream infections. In 2006 Maki reviewed 200 studies that prospectively examined the risk of Bloodstream Infections (BSIs) associated with intravascular devices over a forty year period. The infection rate with peripheral intravenous catheters was 0.5 per 1000 catheter days. Though the frequency of peripheral intravenous catheter-associated infections is lower than with other intravascular devices, absolute numbers of patients affected can be significant with more than 330 million peripheral catheters sold each year in the United States (Millennium Research Group, 2006). Some doctors are stressing the need to use a peripheral line versus early placement of a central line with the rationale to reduce infection rates. Multiple national and international guidelines advocate a number of simple, yet highly effective procedures to reduce risk of central venous catheter infections. Some of these same guidelines should be applied as standards for peripheral catheters. By standardizing protocols across all types of catheter insertions, safety is ensured in reducing infections and ultimately improving patient care.

scholarly journals Reduction of CLABSI in Telemetry Patients through Limiting Central Line Blood Draw

2021 ◽  
Author(s):  
◽  
Caselyn Lok
Keyword(s):  
Healthcare Providers ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Blood Draw ◽  
Central Lines ◽  
Health Complications ◽  
The Many ◽  
Healthcare Associated

CLABSI is known to be one of the many healthcare-associated infections that has led to an increase in health complications, length of hospital stays, and increased in healthcare cost. There is about 25000 bloodstream infection that occurs annually (Haddadin, Annamaraju, & Regunath, 2020). The PICOT question that guided this project was “How does limiting blood-draw from central venous catheter lines influence the rate of central-line associated bloodstream infections (CLABSI) post-implementation compared to rate of CLABSI pre-implementation after eight weeks?” CLABSI prevention bundles were already being used to guide healthcare providers in handling CVC access. There were 15 scholarly articles that supports the use of bundle programs in CVC access and addressing CLABSI. The reduction in handling and manipulation of the CVC access leads to lesser risks of infection. The intervention in this project is the reduction of the CVC access through the limiting of blood draws from central lines with rare exceptions. CVC is primarily used only for the administration of intravenous fluids, antibiotic, parenteral nutrition, and blood products. The intervention utilized a structured decision-making framework to follow during blood draws to avoid using the central line. The project resulted to a reduction of CLABSI rate from 7.9% pre-implementation rate to 0% post-implementation. The limiting of CVC access led to reduced CLABSI episode in the telemetry unit compared to the national average of 5.94%. The project has proven how the intervention implemented can be used in CLABSI prevention bundles to address healthcare associated infections.

scholarly journals What do central venous catheter-associated bloodstream infections have to do with bundles?

2005 ◽  
Vol 16 (4) ◽  
pp. 215-218 ◽  
Author(s):  
BL Johnston ◽  
JM Conly
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Venous Catheter ◽  
The United States ◽  
Central Line ◽  
For Profit ◽  
Healthcare Improvement ◽  
Make Health Care

Interest in the patient safety agenda continues to grow in North America. In the United States (US), the Institute for Healthcare Improvement (IHI) has begun a campaign to make health care safer and more effective by encouraging hospitals to implement interventions they believe can avoid 100,000 deaths between January 2005 and July 2006 (1). The IHI, a not-for-profit organization founded in 1991, promotes the improvement of health by advancing the quality and value of health care (2). Three of the six areas for action chosen by the IHI for their '100,000 Lives Campaign' relate to prevention of nosocomial infections: central line infections, surgical site infections and ventilator-associated pneumonia. In Canada, a grassroots patient safety campaign modelled after the IHI's '100,000 Lives Campaign' has formed (3). This 'Safer Healthcare Now!' campaign focuses on the same six strategies chosen for the '100,000 Lives Campaign'. Across the country, hospitals are being invited to join the 'Safer Healthcare Now!' campaign.

Hiding in Plain Sight: Peripheral Intravenous Catheter Infections

2020 ◽  
Vol 40 (5) ◽  
pp. 57-66
Author(s):  
Barb Nickel
Keyword(s):  
Bloodstream Infections ◽  
Venous Catheter ◽  
Current Evidence ◽  
Evidence Based ◽  
Intravenous Catheter ◽  
Central Venous ◽  
Peripheral Venous Catheter ◽  
Peripheral Intravenous Catheter ◽  
Catheter Infections ◽  
Intravenous Catheters

Topic This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. Clinical Relevance Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter–related bloodstream infections is likely as high as and may surpass the number of central venous catheter–related bloodstream infections, with significant associated morbidity and mortality. Purpose of Paper Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. Content Covered This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.

scholarly journals Risky Business: Peripheral and Central Venous Catheters Both Pose Risks

2019 ◽  
pp. 28-39
Author(s):  
Lynette Hathaway ◽  
Mary Magee
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Venous Access ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Healthcare Facilities ◽  
Relationship Of

Venous access is an essential method of providing life-saving therapy. As part of intensive efforts to decrease the incidence of central line–associated bloodstream infections (CLABSIs), healthcare facilities may be increasing the use of short (noncentral) peripheral venous catheters (PVCs). To investigate this, the Patient Safety Authority (PSA) sought to explore the relationship of actual to predicted complications per central venous catheters (CVCs) and PVCs over a nine-year period. In addition, as PVCs are not without risk and CVCs pose risks aside from infection, we sought to identify the type and relationship of PVC to CVC complications and to quantify the timing and types of PVC and CVC complications and their associated risk factors. A query of the PSA’s statewide event reporting database, the Pennsylvania Patient Safety Reporting System (PA-PSRS), for venous catheter complication events and a query of the National Healthcare Safety Network (NHSN) database for both primary bloodstream infections (BSIs) and CLABSIs occurring at inpatient facilities from January 1, 2009, through December 31, 2017, yielded 115,937 events. A methodical sampling of PA-PSRS yielded 2,413 PVC and CVC events. These were analyzed for the timing of complications reported, the type of complication reported, and any identified risk factors. Overall reports of PVC complications increased, and the correlation between actual and predicted PVC events over the nine years studied is strong and statistically significant. The slight decrease in the number of reported CVC complications was not statistically significant. The authors used regression analysis to determine the best-fitting line through the predicted and actual observed events during the period of observation. These data are not intended to present a predictive model of future events. No correlation was found between the numbers of PVC and CVC complications. The greatest number of PVC complications, particularly infiltration, occurred during catheter maintenance. Excluding NHSN-reported CLABSIs, the greatest number of CVC complications, particularly pneumothorax, occurred during catheter insertion. Education and training are key to preventing intravascular device–associated complications. Healthcare facilities are encouraged to evaluate policy, procedures, and actual practices to eliminate complications and improve outcomes. In addition, quality improvement efforts aimed at decreasing CLABSIs should include measuring CVC complications and all PVC complications as a balancing metric.

scholarly journals National Estimates of Central Line–Associated Bloodstream Infections in Critical Care Patients

2013 ◽  
Vol 34 (6) ◽  
pp. 547-554 ◽  
Author(s):  
Matthew E. Wise ◽  
R. Douglas Scott ◽  
James M. Baggs ◽  
Jonathan R. Edwards ◽  
Katherine D. Ellingson ◽  
...  
Keyword(s):  
United States ◽  
Critical Care ◽  
Bloodstream Infections ◽  
The United States ◽  
Central Line ◽  
Teaching Hospitals ◽  
Annual Number ◽  
Network Systems ◽  
Substantial Progress ◽  
Critical Care Patients

Objective.Recent studies have demonstrated that central line-associated bloodstream infections (CLABSIs) are preventable through implementation of evidence-based prevention practices. Hospitals have reported CLABSI data to the Centers for Disease Control and Prevention (CDC) since the 1970s, providing an opportunity to characterize the national impact of CLABSIs over time. Our objective was to describe changes in the annual number of CLABSIs in critical care patients in the United States.Design.Monte Carlo simulation.Setting.US acute care hospitals.Patients.Nonneonatal critical care patients.Methods.We obtained administrative data on patient-days for nearly all US hospitals and applied CLABSI rates from the National Nosocomial Infections Surveillance and the National Healthcare Safety Network systems to estimate the annual number of CLABSIs in critical care patients nationally during the period 1990–2010 and the number of CLABSIs prevented since 1990.Results.We estimated that there were between 462,000 and 636,000 CLABSIs in nonneonatal critical care patients in the United States during 1990–2010. CLABSI rate reductions led to between 104,000 and 198,000 fewer CLABSIs than would have occurred if rates had remained unchanged since 1990. There were 15,000 hospital-onset CLABSIs in nonneonatal critical care patients in 2010; 70% occurred in medium and large teaching hospitals.Conclusions.Substantial progress has been made in reducing the occurrence of CLABSIs in US critical care patients over the past 2 decades. The concentration of critical care CLABSIs in medium and large teaching hospitals suggests that a targeted approach may be warranted to continue achieving reductions in critical care CLABSIs nationally.

scholarly journals Preparedness and response to an emerging health threat—Lessons learned from Candida auris outbreaks in the United States

2021 ◽  
pp. 1-6
Author(s):  
Diane Meyer ◽  
Elena K. Martin ◽  
Syra Madad ◽  
Priya Dhagat ◽  
Jennifer B. Nuzzo
Keyword(s):  
United States ◽  
New York ◽  
Qualitative Interviews ◽  
The United States ◽  
Lessons Learned ◽  
Infection Prevention And Control ◽  
Healthcare Organizations ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Facilities

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

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