Financial Impact of Hospital-Acquired Infection - Case Study Example

 «The Safety of Extending Peripheral IV Catheter Lines from 72 to 96 Hours» Abstract In searching for peer-reviewed journals, the researcher entered the following search terms and phrases in the databases search engines: ‘peripheral IV line journal’; ‘peripheral IV line 72 to 96 hours journal’; ‘implication prolong used of IV line journal’; ‘Centers for Disease Control and Prevention IV line 72 96 hours’; ‘IV line infection journal’; ‘hand washing IV line infection journal’; and ‘IV line phlebitis journal’ among others. Upon locating the peer-reviewed journals, the researcher identified the major key points which are directly related to the topic of research. In line with this matter, the researcher subdivided the literature part into three (2) parts: (1) a systematic review of literature which provides the readers some information concerning the importance of IV fluids, invasive nature of IV insertion, and the possible causes of IV-related infections; (2) evaluation of the most recent research studies related to the impact of prolonging the use of peripheral IV lines from 72 to 96 hours; and (3) its clinical implications. Research Findings and Conclusion: Nurses should not always rely on the recommendation made by Centers for Disease Control and Prevention. There are a lot of factors that could trigger the development of intravenous-related complications. In general, age is one factor that nurses has to consider when deciding for the best time to replace the intravenous catheter lines. Since neonates and very young children are at higher risk of developing phlebitis, nurses should not wait up to 96 hours before replacing the intravenous devices. For the patients’ safety, nurses should look for signs of intravenous-related complications every time they visit their patient rather than waiting for 96 hours to do the checking. The Safety of Extending Peripheral IV Catheter Lines from 72 to 96 Hours Introduction and Background Recently, the Centers for Disease Control and Prevention have been actively promoting the need to replace peripheral IV catheters between 72 to 96 hours as a way of preventing the patients’ risk of developing infection and/or phlebitis (Machado, Pedreira, & Chaud, 2008; Maki, 2008; Webster et al., 2008; Smith & Royer, 2007; CDC, 2002). Depending on the protocols in each hospital, some health care providers would replace the IV lines every 72 to 96 hours from the time of IV insertion whereas other health care providers may leave the IV lines until there is a clinical signs that the IV line should be replace. Despite the health benefits the patients can receive out of intravenous catheterization, it remains a fact that the infusion of peripheral IV lines into a patients’ body is highly associated with the development of infectious and non-infectious adverse situations. Among the common catheter-related complications includes: (1) the development of infections due to the alteration of the skin integrity; (2) blockage; (3) infiltration or dislodgement of the needle causing phlebitis; and (4) the presence of tissue extravasation. (Machado, Pedreira, & Chaud, 2008; Maki, 2008; Webster et al., 2008) Likewise, it is also possible for the patients to experience unexplainable cause of fever (Webster et al., 2008). The research topic chosen for this study is very much significant to the role and responsibility of professional nurses. Not only does the nurse assist the physicians and other professionals who are qualified to perform the insertion of IV lines but also when it comes to the removal and monitoring of IV lines for signs and symptoms of IV failure. Regardless of the patients’ age and gender, the study will focus on examining the impact of prolonging the use of peripheral IV catheters (from 72 to 96 hours) to patients who are admitted in a hospital. Upon developing the problem statement, a systematic review of literature will be conducted to investigate the primary causes of IV-related infections followed by discussing the most recent research studies that has been conducted to determine the impact of prolonging the use of peripheral IV lines from 72 to 96 hours over the patients’ health and safety. Prior to discussion and conclusion, the clinical implications related to the prolonged use of IV lines will be thoroughly discussed. Problem Statement “The health complications associated with extending the peripheral IV catheter from 72 to 96 hours as recommended by the Centers for Disease Control and Prevention.” Definition of Terms Infiltration – “permeation of intravenous fluid into the interstitial compartment which causes the swelling of the tissue around the catheter site” (Webster, et al., 2008) Intravenous Therapy – referring to the process giving the patients a liquid substance directly into vein. Peripheral Intravenous Lines – the most common intravenous access used within and outside the vicinity of the hospital; the IV is inserted into the patients peripheral vein located in arms or the hands (Kozier et al., 2004: p. 568, 1455). Phlebitis – inflammation of the vein which is characterized by “the presence of pain, tenderness, warmth, erythema, swelling, or a palpable cord” (Webster, et al., 2008) Systematic Review of Literature Intravenous catheterization is one of the most common invasive intravenous procedures being performed in patients who were admitted in a hospital. Basically, the main purpose of administering intravenous fluids on admitted patients is important in terms of promoting electrolyte balance in the human body, for rehydration purposes for patients who are dehydrated due to prolonged diarrhea, to provide the patients with glucose (dextrose) to increase the body’s metabolism, and administration of water-soluble vitamins and other medications into intravenous line. (Kozier et al., 2004: p. 1387) Considering that intravenous insertion is invasive by nature, the patients who are receiving intravenous fluids are at risk of developing hospital-acquired infection. In most cases, the development of intravenous-related infection is related to the failure of health care professionals to apply a strict sterile technique when performing and managing the intravenous insertion and removal process. (O’Grady et al., 2002) For instance: The inability of the nurses to maintain the sterility of the dressing used over the catheter insertion site could result to preventable bacterial infection (Machado, Pedreira, & Chaud, 2008; Sterba, 2001). Considering that the use of intravenous device is invasive by nature, nurses are responsible in practicing aseptic technique before and after touching the dressing of the patients’ intravenous line. Another major source of intravenous-related infection is the cannulation of peripheral intravenous devices. In line with this matter, several studies suggest that nurses should clean the intravenous cannulation carefully to reduce and prevent the patients from becoming infected (Morris & Heong Tay, 2008; Lavery & Ingram, 2006). Other factors such as the proper selection of the catheter type, insertion site, infusion type, insertion techniques, the length of the catheter placement, the type of dressing used in covering the insertion site, and the overall preparation procedure before the insertion of the intravenous lines can also contribute to the development of intravenous-related infection and the development of phlebitis. (Machado, Pedreira, & Chaud, 2008) For instance: The use of good quality dressing materials such as sterile gauze, sterilized transparent and hypoallergenic tapes should also be considered when keeping the insertion site clean and dry. On the other hand, the use of large needle on young children can cause more harm than promoting the overall health and wellness of the patient. Machado, Pedreira, & Chaud (2008) explained that the use of Teflon® and Polyurethane catheters is better than the use of Polyvinylchloride or Polyethylene catheters in terms of causing the patient to develop microorganism infection. This is the main reason why hospitals in the United States are using intravenous catheters that are made of Teflon®, silicone elastomer, or polyurethane rather than the usual polyvinyl chloride or polyethylene. (CDC, 2002) As part of the nurses’ professional duty, nurses should always take matters related to intravenous infection seriously. Failure to acknowledge the importance of proper IV management could result to the patients’ prolonged hospitalization, worsening the health condition of the patients and even causes patients’ untimely death. (Morris & Heong Tay, 2008; Waitt, Waitt, & Piirmohamed, 2004) Evaluation of the most Recent Research Studies Related to the Impact of Prolonging the Use of Peripheral IV lines from 72 to 96 Hours The Centers for Disease Control and Prevention recommended that the use of peripheral intravenous catheter should be extended from 72 to 96 hours. (CDC, 2002) Upon examining the possible health complications associated with extending the recommended time of using the intravenous lines from 72 to 96 hours, some of the most recent research studies suggest that prolonging use of peripheral intravenous lines for more than 72 hours could increase the rate that the patient would develop either thrombophlebitis and/or bacterial catheter colonization but not the incidence of phlebitis (Lai, 1998; Maki & Ringer, 1991). Related to the prolonged use of intravenous devices, the research study that was conducted by Gilles et al. (2008) revealed that there are no sufficient evidences that can prove that changing the intravenous administration set more frequently than the recommended time set by the Centers for Disease Control and Prevention can effectively reduce the incidence of bloodstream infection in patients. Basically, the use of intravenous administration set that does not have any blood or lipids can be safely use even up to 96 hours without having to think about the risk that the patient might be infected (Gilles et al., 2008). On top of the research findings of Gilles et al. (2008), Gilles et al. (2004) revealed that there are quite a lot of research studies made in the past that can provide sufficient evidences that changing the intravenous administration set every 72 hours or more will not increase the patients’ risk of developing infusate-related bloodstream or catheter-related infection. Considering that the development of phlebitis and bacterial catheter colonization is related to the patients’ increase risk for intravenous-line infection, CDC (2002) suggest that nurses should be encouraged to continuously rotate the use of peripheral catheter sites every after 72 to 96 hours. This particular medical practice is effective in terms of minimizing the patients’ discomfort and the possibility that the patients would have infection. As part of determining the possible impact of prolonging the use of peripheral intravenous lines, Webster et al. (2008) conducted a randomized controlled study to test the differences between replacing the catheters every three days based on the hospital policy with 376 participants and leaving the catheters for a longer period of time until there is a clinical indication to replace the intravenous lines with 379 participants. Since the rate of the development of phlebitis between the two groups is low and the absence of relationship between the routinary replacement of peripheral catheters with the incidence of intravenous catheter failure, Webster et al. (2008) concluded that there is no significant differences between replacing the intravenous lines every after three days and as soon as there is a clinical indication to replace the intravenous lines. Aside from causing unnecessary painful intervention on the patients (Schultz & Gallant, 2005), the replacement of the intravenous lines every three days (even without clinical indication for replacement) could only add the patients’ financial burden. Contrary to the research findings of Webster et al. (2008), Foster et al. (2002) found out that prolonging the insertion of peripheral intravenous catheters in neonates, infants, and children for more than 72 hours increases the patients’ risk of developing phlebitis. Basically, the risk of developing phlebitis increases when the patient is either a neonate or is very young and when the patient is receiving medication from intravenous fluid (Foster et al., 2002). Clinical Implications Due to the clinical implications related to the insertion of peripheral intravenous lines, the replacement of intravenous lines is a part of medical practice that we should seriously consider. Before changing the intravenous lines, health care professionals should always balance the advantages and disadvantages of replacing the intravenous lines. Even though the Centers for Disease Control and Prevention has publicly announced extending the use of peripheral intravenous lines from 72 to 96 hours, nurses should always be aware that there is really no fix time on when the health care professionals should replace the intravenous lines. For instance: Although the intravenous insertion has not reached 96 hours, the health care professionals should continuously observe any signs of needle dislodgement, occurrence of phlebitis, difficulty in regulating the intravenous fluid, and the unknown cause of fever among others. If any of these signs are present, the health care professionals should still remove the peripheral intravenous lines even though the health care professionals have just inserted a new intravenous line. This is probably the main reason that makes the average duration of catheterization in hospitals seldom exceeds three to four days. (Maki, 2008) Upon examining the existing knowledge of the nurses with regards to the proper management and the compliance with the use of intravascular devices, Lopez et al. (2004) revealed that most of the nurses scored higher during the post-test as compared with the pre-test. The study result only shows that the knowledge and compliance with the hospital protocols can still be improved in order to prevent the number of intravascular device-related complications (Lopez et al., 2004). In order to minimize the possible risk of developing intravenous catheter-related complications, it is necessary for the hospitals to provide the health care professionals who are directly and indirectly involved with intravenous insertion and monitoring of intravenous lines with sufficient educational and training support. Basically, increasing their knowledge with the importance of applying sterile technique during intravenous insertion and removal process could lessen the patients’ risk of acquiring hospital-acquired infections (O’Grady et al., 2002). For example: Health care professionals who has the authority to perform intravenous insertion including the nurses who are going to assist the physician during the insertion process should make it a protocol to wash hands with antiseptic soap and water or use alcohol-based gels before and after the insertion of intravenous lines. (CDC, 2002) Likewise, it is also highly recommended for the physician to use of sterile gloves every time they insert intravenous administration set on patients. Discussion Several studies revealed that there is no clear connection between intravenous catheter failure and the frequency of intravenous catheter line replacement. (Gilles et al., 2008; Webster et al., 2008; Gilles et al., 2004) With regards to this matter, Webster et al. (2008) suggest that it is possible for catheters to remain functional even with a prolonged use provided that the intravenous line is not dislocated. As of 2008, the recommended routine replacement of peripheral intravenous catheters in the United States is 24 hours longer than the existing guidelines in the United Kingdom and Australia (Maki, 2008). With the purpose of promoting safety precautionary measures associated with extending the peripheral intravenous catheter lines from 72 to 96 hours, developing a standardization program for both the delivery of medicine infusion, insertion, and management of of peripheral intravenous lines must be promoted to increase the patients of their safety (Apkon et al., 2004). Intravenous-related infection is often associated with the improper aseptic practice. For this reason, nurses should always wash their hands with anti-microbial soap and water before assisting the physician when inserting the intravenous administration set, prior to the removal of the hep lock, and/or when changing the dressing cover of the insertion site. Basically, developing a hospital protocol related to the strict implementation of hand washing before attending to the patient is very important for the safety of the patients who are admitted in a hospital. By ensuring that each of the health care professionals would comply with the hospital regulation on proper hand washing technique, there is a lesser chance for health care professionals to transfer micro organisms from one patient to another. Conclusion One of the main duty and responsibility of the nurses is to provide a holistic care for their patients. Considering the fact that it is ethical for nurses to avoid harming the patients either directly or indirectly, nurses should avoid relying too much with the recommended replacement time as set by Centers for Disease Control and Prevention. Extending the use of peripheral intravenous catheter line up to 96 hours is possible. However, there are a lot of factors that could trigger the development of intravenous-related complications. For instance, age is one factor that nurses has to consider when deciding for the best time to replace the intravenous catheter lines. Since neonates and very young children are at higher risk of developing phlebitis, nurses should not wait up to 96 hours before replacing the intravenous devices. On the other hand, nurses can consider replacing the intravenous administration set on adult patients on or before 96 hours from the time of intravenous insertion provided that the nurses should make it a habit to routinely check for signs and symptoms of health complications caused by the use of intravenous devices. By constantly looking for signs of intravenous-related complications every time the nurses visit their patients, the health care administration team could have a better assurance that their patients are safe from the adverse health and financial impact of hospital-acquired infection. References Apkon, M., Leonard, J., Probst, L., DeLizio, L., & Vitale, R. (2004). Design of a safer approach to intravenous drug infusions: failure mode effects analysis. Quality and Safe Health Care , 13, 265 - 271. CDC. (2002, August 9). Retrieved January 18, 2009, from Guidelines for the Prevention of Intravascular Catheter-Related Infections: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm Foster, L., Wallis, M., Paterson, B., & James, H. (2002). A Descriptive Study of Peripheral Intravenous Catheters in Patients Admitted to a Pediatric Unit in One Australian Hospital. Journal of Infusion Nursing , 25(3), 159 - 167. Gilles, D., O'Riordan, L., Wallen, M., Rankin, K., Morrison, A., & Nagy, S. (2004). Timing of Intravenous Administration Set Changes: A Systematic Review. Infectious Control Hospital Epidemiology , 25, 240 - 250. Gilles, D., Wallen, M. M., Morrison, A. L., Rankin, K., Nagy, S. A., & O'Riordan, E. (2008). Optimal timing for intravenous administration set replacement. The Cochrane Collaboration , 4, 1 - 75. Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of Nursing: Concepts, Process, and Practice. Pearson Prentice Hall. Lai, K. (1998). Safety of prolonging peripheral cannula and i.v. tubing use from 72 hours to 96 hours. American Journal of Infection Control , 26(1), 66 - 70. Lavery, I., & Ingram, P. (2006). Prevention of infection in peripheral intravenous devices. Nursing Standard , 20(49), 49 - 56. Lopez, V., Molassiotis, A., Chan, W., Ng, F., & Wong, E. (2004). An intervention study to evaluate nursing management of peripheral intravascular devices. Journal of Infusion Nursing , 27(5), 322 - 331. Machado, A., Pedreira, M., & Chaud, M. (2008). Adverse Events Related to the Use of Peripheral Intravenous Catheters in Children According to Dressing Regimens. Rev Latino-am Enfermagem , 16(3), 362 - 367. Maki, D. G. (2008). Improving the safety of peripheral intravenous catheters. BMJ , 337(7662), 122- 123. Maki, D., & Ringer, M. (1991). Risk factors for infusion-related phlebitis with small peripheral venous catheters: a randomized controlled trial. Annals of Internal Medicine , 114(10), 845 - 854. Morris, W., & Heong Tay, M. (2008). Strategies for preventing peripheral intravenous cannula infection. British Journal of Nursing , 17(19), S14 - 521. O’Grady, N. P., Alexander, M., Dellinger, P., Gerberding, J. L., Heard, S. O., Maki, D. G., et al. (2002). Guidelines for the Prevention of Intravascular Catheter–Related Infections. Infection Control and Hospital epideiology , 23(12), 759 - 769. Schultz, A. A., & Gallant, P. (2005). Evidence-based quality improvement project for determining appropriate discontinuation of peripheral intravenous cannulas. Evidence-Based Nursing , 8, 8. Smith, B., & Royer, T. I. (2007). New standards for improving peripheral I.V. catheter securement. Doing It Better. Nursing , 37(3), 72 - 74. Sterba, K. (2001). Controversial Issues in the Care and Maintenance of Vascular Access Devices in the Long-term/Subacute Care Client. Journal of Infusion Nursing , 24(4), 249 - 254. Waitt, C., Waitt, P., & Piirmohamed, M. (2004). Intravenous therapy. Postgraduate Medical Journal , 80(939), 1 - 6. Webster, J., Clarke, S., Paterson, D., Hutton, A., van Dyk, S., Gale, C., et al. (2008). Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. BMJ , 337(7662), 157 - 160. Read More