Reducing the prevalence of antecubital fossa peripheral intravenous cannulation
Observational studies have found that placement of peripheral intravenous cannulas (PIVCs) in the antecubital fossa (ACF) is associated with increased risks of infection, including healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB). Avoiding placement of the PIVC in the ACF area along with other preventive measures such as aseptic technique, staff education on documentation, standardised insertion packs and alerts for timely removal, may reduce the overall risk of acquiring an HA-SAB. Aim: To implement a multimodal awareness programme on ACF cannulas and the risk of infection, and to reduce PIVC-associated HA-SAB in one hospital in Australia. Method: The authors performed a baseline digital survey to identify root causes for clinical decision making related to PIVCs and to raise awareness of the project. The authors performed weekly audits and provided feedback on four key wards over 12 weeks. Simple linear regression was used to look at the trend of ACF cannulation rates over time. HA-SAB rates were calculated per 10 000 occupied bed days. Findings: Improved insertion documentation was observed during the intervention period. The ACF cannulation rates decreased by 0.03% per day during the study, although this did not quite reach statistical significance (P=0.06). There were no PIVC-associated SAB events during the intervention period. The SAB rates decreased by 0.02% per day over the period of the study.
Peripheral intravenous cannulas (PIVCs) are among the most used devices in hospitalised patients (Carr et al, 2017; Australian Commission on Safety and Quality in Healthcare (ACSQH), 2021a). Optimal management of PIVCs is important to reduce the risks of infection, including healthcare-associated Staphylococcus aureus (Staph. aureus) bacteraemia (HA-SAB) bloodstream infections (BSIs) (New South Wales (NSW) Ministry of Health, 2019). PIVCs account for almost a quarter of the HA-SABs in Australia (Rhodes et al, 2016) ahead of surgical site infections and infections caused by central venous catheter and other indwelling devices (Rhodes et al, 2016; ACSQH, 2021b).
On insertion, a PIVC breaches and traumatises the skin, the natural barrier to foreign objects and, potentially, provides a conduit for microorganisms to form biofilms on the catheter (Grice and Segre, 2011; Byrd et al, 2018). When bacteria colonise the external surface of the catheter, there is potential for them to migrate down the length of the catheter and enter the bloodstream (Mermel, 2017; Bitmead and Oliver, 2018). Bacteria can also enter the bloodstream through the contamination of the hub/lumen of the PIVC (Mermel, 2017; NSW Ministry of Health, 2019; ACSQH, 2021a).
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