June 23, 2017 6:29 am
Central line associated bloodstream infections (CLABSI) can lead to excess length of hospital stay and increased risk of mortality. Ever since they became a reportable Centers for Medicare & Medicaid Services (CMS) outcome measure though, there has been a 46 percent reduction in CLABSIs in hospitals across the country. However, nearly 30,000 CLABSIs still occur in hospitals each year. 1
Peripherally inserted catheters (PIV) can also be a source of bloodstream infections and are starting to receive some notice. Because central line associated bloodstream infections are only currently part of the CMS value based purchasing metrics, the true impact of PIV related bloodstream infections are not known. Most infection prevention programs do not include this type of surveillance. In 2014, both the Society for Healthcare Epidemiology Association (SHEA) and INS acknowledged that infections do occur from short peripheral catheters and introduced the thought that surveillance may need to be expanded to these devices in the future.
The decision to replace the short peripheral catheter should be based on assessment of the patient’s condition; access site; skin and vein integrity; length and type of prescriber therapy; venue of care; integrity and patency of the vascular access device and stabilization device.2,3 The following are three reasons to consider expanding clinician thinking around PIV replacement.
Increase in cost savings
Studies show that increased PIV dwell times may not be as closely associated with risk of infection. A 2010 Cochrane Study investigated whether there was really any benefit to replacing a PIV every three to four days. The study concluded that there was no benefit in terms of infection or phlebitis from routinely replacing PIV sites versus leaving them in until no longer clinically indicated. In 2011, the CDC updated their recommendations and now advises that PIVs should be changed no more frequently than every 72 to 96 hrs.4
Fewer PIV starts mean fewer kits, which can help increase cost savings for healthcare organizations.
Decrease on time spent starting PIVs
PIV insertion is considered to be the most common invasive hospital procedure worldwide with 70 to 80 percent of patients receiving a PIV during their hospital stay5. Even when inserted by the best vascular access clinician, it has a failure rate of 35 to 50 percent and is associated with a variety of complications, including phlebitis and bloodstream infections. Decreasing how often clinicians replace PIVs allows them to focus their time on other important patient care tasks.
Improve patient satisfaction
The literature has shown that infection rates for PIVs are lower than for CLABSIs, but PIV utilization may be four times higher than central line utilization, so the total number of infections is not insignificant.6 PIV insertion is not the most comfortable procedure, so limiting painful IV insertion sticks can help hospitals enhance patient satisfaction score.
The time is now to consider developing a strategy to include PIVs as part of a hospital’s bloodstream infection prevention program. Key components of a plan should include using evidence-based guidelines to inform decision making and selection of a bundle of products to support objectives. Implementing such a plan can positively impact patients, staff and the hospital’s bottom line.
The Michigan Vascular Access Society has recently started to hold journal clubs where key opinion leaders discuss the newest trends in vascular access and the prevention of BSIs. To learn more visit PICC Excellence online for access to free webinars.
How we look at all vascular access devices and their association with infection are changing. What are you doing at your hospital to go beyond the prevention of CLABSI and including the prevention of BSI from PIVs?
By: Barbara Connell
- Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and non-central line-associated Bloodstream Infection). CDC website. January 2017. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf . Accessed May 19, 2017.
- INS 2011
- INS 2016
- O’Grady et , 2011
- Zingg & Pittet, 2009
- (Wischnewski et al., 1998)