Reducing bloodstream infections with a peripheral intravenous catheter bundle at 38 Australian hospitals: A quality improvement initiative

BACKGROUND: The Australian Commission released the 'Management of Peripheral Intravenous Catheters (PIVC): Clinical Care Standard' in 2021. In response, a nationwide private health service reviewed current practice to ensure alignment with evidence-based PIVC insertion and management and aim to reduce associated Staphylococcus aureus bloodstream infections (SABSI). METHODS: A quality improvement project to develop and implement an evidence-based PIVC bundle was conducted across 38 private hospitals Australia-wide during 2022-2023. A complete review of existing policies and practices was undertaken, followed by implementation of a bundle consisting of a service-wide PIVC policy, nursing documentation, I-DECIDED® tool, audit tool, and risk reporting; prefilled saline flush syringes; and updated consumer information. Measures included monitoring infection and complication data; ongoing audits of bundle compliance; a time-and-motion study to assess the effect of prefilled flush syringes on clinician workflow and economic costs; and staff satisfaction surveys. RESULTS: Since 2022, overall SABSI decreased by 21 % and intravenous catheter SABSI decreased by 10 %. Local PIVC infection reduced by 55 %. Ongoing audits demonstrate improvement for all quality statements of the Standard, including documentation of insertion attempts (from 32 % to 65 %) and overall documentation (from 74 % to 83 %). Use of ultrasound for difficult insertion increased from 21 % to 30 %. Documentation of consumer education and consent improved from 47 % to 80 %. Time-and-motion observations identified a 49-s time saving using prefilled flush syringes. Staff satisfaction scored above 90 %. CONCLUSION: Implementation of the bundle resulted in SABSI reduction, reduced local PIVC infection, greater compliance with the Standard, nursing time savings, and improved staff satisfaction.