A quality improvement study to reduce peripheral intravenous catheter-related complications in the medical ward of a tertiary hospital in Malaysia

Abstract

Background: Peripheral intravenous catheters (PIVCs) are associated with complications which can be prevented by implementing evidence-based practices around appropriate PIVC insertion and care. We aimed to conduct a quality improvement study (QIS) to reduce PIVC-related infection/inflammation in the medical ward of a tertiary teaching hospital in Malaysia. Methods & Materials: This QIS was performed in the infectious diseases ward of the University Malaya Medical Centre (UMMC) from December 2018 to September 2019 and divided into three phases. The pre-intervention phase (December 2018 to January 2019) involved data collection to determine the incidence of PIVC-related infection/inflammation, discrepancies in the assessment of PIVC-related infection/inflammation and assessment of the knowledge, attitude and perception (KAP) of the healthcare workers (HCW) regarding PIVC care. The intervention phase (February 2019) involved feedback of the pre-intervention data to the HCWs and education (formal lectures, development and presentation of online videos of PIVC insertion and care). The post-intervention phase (March to September 2019), involved data collection to determine the incidence of PIVC-related infection/inflammation and re-administration of the KAP questionnaire. Audits of IV line handling and infusate administration technique were conducted from March to August 2019. Results: Prior to intervention, the rate of PIVC-related infection/inflammation was 15.4%, which reduced to 2.3% following intervention. No PIVC-related bacteraemia occurred. Prior to intervention, the discrepancy in assessment of PIVC-related infection/inflammation was 7.9%, with a decrease to 0% post-intervention. Analysis of the KAP questionnaire responses pre and post-intervention revealed an improvement from 60% to 90% for the question ‘How long would you wait for the disinfectant to dry after scrubbing the hub?’. The audits of IV line handling and infusate administration revealed an 11–31% rate of staff not tucking in ties, lanyards or scarves when performing these tasks, an 11% rate of not ‘scrubbing the hub’ for 15 seconds and not allowing it to dry before use, and up to a 100% rate of not cleaning used equipment appropriately after use. Conclusion: We demonstrated a significant reduction in PIVC-related infection/inflammation following feedback and education of best evidence-based practices on PIVC insertion and care. We now plan to expand this QIS to other wards in the hospital.