Patient Safety- Improving IV Catheter Care In Hospitals

Originally published in July/August issue of Patient Safety & Quality Healthcare magazine

By Denise Macklin, BSN, RNC, and Cynthia Chernecky, PhD, RN, AOCN, FAAN

As recently reported by the Centers for Disease Control and Prevention (CDC; 2010), the incidence of bloodstream infections associated with central venous catheters (central lines) has dropped 18%. The report compared data from January to June 2009 to data from 2006 to 2008. This drop is important because it suggests that a national effort to prevent the infections is having some impact. But a report earlier this year from the Agency for Healthcare Quality and Research (2010), using a different methodology, concluded that there has been no nationwide drop in these infections, despite years of effort by clinicians, industry, and healthcare institutions.

Whatever the actual numbers, the infection-fighting task is far from complete. Many experts believe that catheter-related bloodstream infections (CR-BSI) are entirely preventable. Yet an estimated 30,000 patients per year lose their lives to these infections (APIC, 2010). CR-BSI, which cost tens of thousands of dollars on average to treat, also contribute substantially to healthcare costs. Those are costs that hospitals themselves often now bear because the Center for Medicare and Medicaid Services (CMS), agreeing that these complications are avoidable, stopped reimbursing hospitals for CR-BSI in 2008 (Medicare Program). 

The healthcare community has an obligation—and a strong financial incentive—to remain focused on the goal of completely eliminating CR-BSI until that goal is achieved. In part by focusing on antimicrobials such as dressings and on technologies such as advanced IV connectors, many institutions can achieve this goal.

Why do unacceptable rates of these infections persist? There are several reasons:

• The origins of CR-BSI are poorly understood at many institutions, so prevention efforts are often poorly targeted.
• When facilities do establish sensible, evidence-based prevention policies, compliance with them is inconsistent.
• Current prevention guidelines from prominent organizations such as the Institute for Healthcare Improvement (IHI) and Society for Healthcare Epidemiology of America (SHEA) describe a consensus approach that is inherently minimalist. A more comprehensive approach drawing upon recent research findings is likely to be more effective.
• Some institutions may not be responding promptly
• to catheter occlusions (also known as clogging), which are a known risk factor for bloodstream infections.
• There is relatively little research on effective catheter technology, care, and maintenance given the prevalence of catheter placements in contemporary medicine.
• Some institutions may not be addressing problems appropriately—that is, making appropriate changes in response to a high CR-BSI rate at their facility. 

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