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.

Emergency inserted peripheral intravenous catheters: a quality improvement project.

Vascular access devices are common and necessary in healthcare provision but their use poses a significant risk of acquiring an infection. Ambulance/emergency inserted peripheral intravenous catheters (PIVCs) potentially have higher risks of catheter-related bloodstream infection (CRBSI) because of the inability to maintain asepsis during the insertion procedure. Local guidelines (Queensland, Australia) recommend the removal or replacement of PIVCs inserted in these situations within 24 hours. Routine clinical audits performed within the authors' health service demonstrated a delay in removing ambulance/emergency inserted PIVCs beyond acceptable dwell times. Ambulance/emergency inserted PIVCs were not being recognised as requiring removal by ward staff. A quality improvement project involving key stakeholder engagement, the roll out of a sticker to readily identify ambulance/emergency inserted PIVCs and education of ward staff was introduced to enable identification of this high-risk group. Post-implementation audits demonstrated a significant reduction in numbers of ambulance/emergency PIVCs remaining in situ for longer than 24 hours.