With the aim to reduce the rate of peripheral intravenous catheter (PIVC) related bloodstream infections (BSIs) at the Townsville University Hospital, a six-month quality improvement activity was initiated through education, patient engagement, and surveillance.
Healthcare-associated BSIs (HA-BSIs) have a significant burden on the healthcare system and are largely associated with increased risk of patient morbidity and mortality.1
Most HA-BSIs are preventable through basic infection prevention and control practices.1 To commit to reducing the issue of HA-BSIs, the Australian Commission on Safety and Quality in Health Care1 released the new ‘Management of PIVCs Clinical Care Standard’ in 2021.
The Townsville Hospital and Health Service (THHS) Infection Prevention and Control Team identified gaps in meeting the new Standard, which included a lack of evidence that inpatients were receiving information about caring for their PIVC, an increase in hospital acquired BSIs in the medical and surgical wards, and poor compliance with routine PIVC documentation.
To reflect the changes from the new Standard the THHS updated the relevant policies, audit tools, and clinical competency assessments. To address the shortcomings, the Infection Prevention and Control Team initiated a six-month quality improvement activity in the medical and surgical wards, which aimed to improve staff education and awareness, patient engagement, rates of PIVC-related HA-BSI, and compliance with documentation.
The interventions included PIVC education for consumers with the support of a ‘Caring for your cannula’ brochure, in-services for nursing staff, and regular audits of PIVC documentation with feedback to the wards.
The results of this activity reflected a positive impact on the rate of PIVC-related HA-BSIs. The rate in the focus wards decreased from 0.67 cases per month to 0.33 cases per month (eight cases in the 12 months pre-intervention and two cases during the intervention period). In comparison, the wards, which did not receive the intervention had an increase from one case per year to six cases in 2022. Patient education was delivered steadily at an average rate of seven patients per month. Despite delivering 14 ward-based in-services there was no improvement in clinician documentation with the baseline average of 1,361 patients per month with incomplete documentation increasing to 1,374 per month during the intervention period.
These results were impacted by the COVID-19 pandemic, which hindered the team’s ability to enact a consistent implementation strategy. Therefore, education sessions for staff and patients were provided sporadically and ward pressures limited staff ability to attend in-services.
The validity of the HA-BSI data from this activity is limited due to the small sample size, additionally there is no proof of a causal relationship between the intervention and the improvement in HA-BSI rates.
Despite this, the initiative has laid the foundations for further research regarding the barriers to compliance with PIVC documentation and management to inform interventions that may be more effective to implement. Our team is now investigating strategies to effectively implement change and gather more rigorous data.
Australian Commission on Safety and Quality in Health Care. Management of Peripheral Intravenous Catheters Clinical Care Standard [Internet]. Sydney: Australian Commission on Safety and Quality in Health Care; 2021 May [cited 2022 Aug 27]. 54 p. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/management-peripheral-intravenous-catheters-clinical-care-standard-2021
Chiane Marshall, RN, Clinical Nurse Infection Prevention and Control at the Townsville University Hospital