A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters

Abstract

Background: Peripheral intravenous catheters (PIVs) have been considered as having lower risk of infection than central lines. However, research is limited regarding numbers of primary bloodstream infections related to peripheral lines and prevention of peripheral line-associated bloodstream infections (PLABSI). Methods: Our aim was to create and monitor compliance with a new PIV maintenance bundle using disinfecting caps and tips and to assess whether this bundle would lead to a decrease in PLABSI rates. Weekly audits were conducted to measure compliance with both the new PIV bundle and our existing central line-associated bloodstream infection (CLABSI) bundle. We also audited the disconnection method used for intravenous line tubing (peripheral and central lines) before and during the study intervention period. Results: A compliance rate of close to 90% with the use of the disinfecting caps and tips was attained. Using a PLABSI bundle successfully decreased primary bloodstream infections due to PIVs (from 0.57 infections per 1000 patient-days preintervention to 0.11 infections per 1000 patient-days; p < 0.001). We confirmed that improving care for PIVs would decrease primary bloodstream infections associated with these devices. Conclusions: Using a PIV maintenance bundle including disinfecting caps and tips can effectively lower the rate of primary bloodstream infections attributable to PIV lines.

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review

“…All included studies reported implementing a PIVC care bundle for insertion (n Z 9) or maintenance (n Z 10), or both (n Z 8) in an acute care hospital inpatient setting. Studies were conducted in a range of countries, including Australia [32,36], USA [25,26,29], UK [27], Spain [30,33], Germany [34], Taiwan [24], South Korea [31], and Thailand [35]. Bundles were implemented for the adult (n Z 10), paediatric (n Z 2), and neonate (n Z 1) populations.…”

Predicting and reducing “hospital‐acquired infections” using a knowledge‐based e‐surveillance system

“…This unit collects patient data from hospitals locally or remotely from the portal's website and by using laptops, the Internet, hospital databases, and scanners. Table illustrates a part of the injury model in the primary bloodstream and completion instructions (Duncan, Warden, Bernatchez, & Morse, ). To determine whether a patient has CLABSI infection, further data and symptom criteria should be used, as explained in the next sections.…”

“…A positive blood culture with ciphers and symptoms of infection is evidence of blood infection. The patient may develop HAI‐CLABSI status if patient suffers from fever or chills, or skin around the catheter becomes sore and red; when the BSI arises and there is no other possible source of this infection; infection is related to the central line; and the infection is possibly from an alternative source, but the source is obscure (Duncan et al, ). …”

“…4. the infection is possibly from an alternative source, but the source is obscure (Duncan et al, 2018).…”

“…illustrates a part of the injury model in the primary bloodstream and completion instructions(Duncan, Warden, Bernatchez, & Morse, 2018). To determine whether a patient has CLABSI infection, further data and symptom criteria should be used, as explained in the next sections.…”