All intravenous catheters represent a potential entry site for bacteria and the beginning of a bloodstream infection. Central lines have been vigilantly protected for many years now, even though peripheral IV lines are much more common. In fact, 200 million patients have PIVs placed each year compared to only 5 million central lines placed annually. Historically PIV lines, due to shorter wear times and placement locations have been deemed less risky. Yet, PIVs deserve to be protected just as vigilantly since any BSI, whether peripheral line-associated bloodstream infections (PLABSI) or central line-associated bloodstream infection (CLABSI), is a major concern.
While historically PIVs have not received as much attention, a team of researchers at Mercy Hospital in St. Louis, MO set out to change that. They reduced PLABSIs by 81% during their study intervention period. That is a decrease from 0.57 to 0.11 per 1000 patient days (p<0.01). The study looked at the impact a comprehensive PIV maintenance bundle could have on reducing peripheral line-associated bloodstream infections.
They developed the bundle based on the Centers for Disease Control and Prevention, Infusion Nurses Society and Society for Healthcare Epidemiology of America compendium guidelines. It included multiple components such as assessing and removing PIV catheters at the first sign of phlebitis and monitoring and changing the dressing if nonocclusive or if blood was present. Mercy Hospital had also been successfully using disinfecting caps on central lines for five years and added 3M™ Curos™ Disinfecting Cap for Needleless Connectors to the PIV catheter maintenance bundle as a preventative method. In addition, they added 3M™ Curos™ Tips Disinfecting Cap Strip for Male Luers to all disconnected IV tubing, to replace inconsistent methods of managing the intermittent tubing that had previously been used.
During the study, compliance with disinfecting cap use increased across the board:
• 89 percent compliance with disinfecting caps on PIV lines
• 84 percent compliance with disinfecting tips on disconnect IV tubing
• 94 percent compliance with disinfecting caps on central lines (up from 84 percent before intervention period)
These high compliance rates indicate that PIV maintenance bundles are easy to integrate into existing workflows and do not add extra effort to a nurse’s busy day. The findings of this study also support that a bundled approach is effective for reducing infection and can help lead a cultural shift in the healthcare community that elevates PIV standards to the level of central lines.
The results Mercy achieved by implementing PIV maintenance bundles can be replicated at other facilities. If you are interested in doing more to prevent PLABSIs, talk with your 3M representative and ask how your partner can help evaluate your current PIV bundle.