Decreasing Peripheral Intravenous Catheter (PIV) Associated Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteremia

Abstract

<h3>Background</h3> A 210-bed community hospital experienced 13 MRSA bacteremia events from July 2017 - June 2019. Among those infections, 46.2% were associated with the use of a PIV. Review of MRSA bacteremia infections identified a lack of standardized prevention measures in patients with PIVs. <h3>Methods</h3> A multidisciplinary team was assembled consisting of Infection Prevention (IP), nursing, anesthesia, and Emergency Medical Services (EMS) to create and implement a PIV bundle. The bundle included labeling, dating, and assessing intact, clean dressings. Following bundle development, education was conducted across the hospital via skills fair with hands-on training and roving in-services to ensure 90% of affected staff were reached. IP collected pre-intervention data and bundle audit data weekly to monitor improvement. During audits, the IP performed just-in time education and feedback on bundle non-compliance. PIV-bacteremia prevention education was incorporated into orientation for new nurses. Additional education was conducted with Anesthesia and EMS providers on PIV insertion technique and infection prevention processes. <h3>Results</h3> Baseline compliance with PIV-bundle components was 13.6% and increased to 69.0% in December of 2019 when the project ended. Dressing cleanliness increased from 66.0% in the baseline period to 88.7% Current data in December 2021 indicates an overall PIV bundle compliance rate of 80.6% demonstrating sustainability in the intervention. PIV-associated MRSA bacteremia decreased from 1.04 infections/10,000 patient days to 0 infections/10,000 patient days (p = 0.008). <h3>Conclusions</h3> PIV-associated bacteremia can be a major contributor to overall MRSA bacteremia. A comprehensive PIV bundle with stakeholder engagement is an effective intervention to reduce MRSA-bacteremia. Improving PIV maintenance practices reduces MRSA bacteremia.