IV maintenance bundle compliance
Abstract:
Background: The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; haemodialysis, HD ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analysed the effect of intensive training and education of healthcare workers (HCW) on maintenance bundle for venous access devices.
Methods: The study period comprising of pre-intervention phase (3-months) included 25 random visits to intensive care unit (ICU) for point observations regarding maintenance of all venous access devices in-situ in all ICU patients on the day of visit. The observations were categorized as appropriate or inappropriate practices based on ASA guidelines for CVC 2020, INICC guidelines for PIVC 2017 and ACQHCS for PIVC and haemodialysis ports, Dec 2019. While intervention phase (1-month) comprised of intensive training and education of HCWs, post-intervention phase 3 (3-months) included similar visits and point observations as during pre-intervention phase.
Results: The maintenance of PIVC improved significantly in terms of condition of site (from 82.7% appropriate observations to 97.8%,p<0.05); condition of connectors (45.7% to 56.8%,p<0.05) and any attached unused iv sets (90.5% to 98.56%,p<0.05). For CVC, there was significant improvement in condition of insertion site (66% to 94%,p<0.01); condition of connectors (0% to 44.37%,p<0.01); fixation (91% to 99.3%,p<0.05); any attached unused iv sets (38.9% to 97.3%,p<0.01) and knowledge of HCW (96.52% to 100%,p=0.05). For HD ports, no significant improvement was observed.
Conclusion: Intensive training and education of HCWs led to significant improvement in maintenance bundle of care for PIVC and CVC.
Reference:
Sharma R, Gandhi KA, Biswal M, Kaur K, Sahni N, Yaddanapudi L. Effect of intensive training and education of healthcare workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital. Am J Infect Control. 2023 Jul 18:S0196-6553(23)00505-9. doi: 10.1016/j.ajic.2023.07.002. Epub ahead of print. PMID: 37474007.