A bundled approach to IV site care and maintenance

Abstract

Hospitalized patients receiving medications intravenously are at increased risk for developing hospital associated infections (HAIs), including MRSA if their peripheral intravenous catheters are not maintained appropriately. These HAIs pose a financial burden to both patients and institutions and increased morbidity and mortality for the patient. A bundled set of evidence-based interventions was implemented on three acute care units as part of a quality improvement project. The aim of the project was to ensure proper care and maintenance of intravenous catheter devices. Interventions included a) consistent use of a phlebitis infiltration scale; b) maintaining a clean, dry, and intact dressing with a securement device; and c) using a disinfecting cap on all catheter hubs and tubing. Nursing staff were educated using huddles, purposeful rounding, posters, videos, and reminder cards. Compliance with the bundled elements was measured using an audit tool during weekly point prevalence rounds. Post implementation data showed a 65% reduction in MRSA incidence rates. The compliance scores for all elements increased, on average, by 58% from 34.5% to 92.5%. The results suggest that the implementation of a bundled approach to the care and maintenance of PIVCs is clinically effective at reducing the incidence of MRSA bacteremia.