Highlights
- •Improving PIVC auditing practices will help identify early signs of infection.
- •PIVC audit should be between 100 and 250 PIVCs per audit round.
- •Auditing of PIVC care is an effective method to promote best practice and improve clinical care.
Abstract
Background
Peripheral intravenous catheters (PIVCs) are medical devices used to administer intravenous
therapy but can be complicated by soft tissue or bloodstream infection. Monitoring
PIVC safety and quality through clinical auditing supports quality infection prevention
however is labour intensive. We sought to determine the optimal patient ‘number’ for
clinical audits to inform evidence-based surveillance.
Methods
We studied a dataset of cross-sectional PIVC clinical audits collected over five years
(2015–2019) in a large Australian metropolitan hospital. Audits included adult medical,
surgical, women's, cancer, emergency and critical care patients, with audit sizes
of 69–220 PIVCs. The primary outcome was PIVC complications for one or more patient
reported symptom/auditor observed sign of infection or other complications. Complication
prevalence and 95% confidence interval (CI) were calculated. We modelled scenarios
of low (10%), medium (20%) and high (50%) prevalence estimates against audit sizes
of 20, 50, 100, 150, 200, 250, and 300. This was used to develop a decision-making
tool to guide audit size.
Results
Of 2274 PIVCs evaluated, 475 (21%) had a complication. Complication prevalence per
round varied from 7.8% (95% CI, 4.2–12.9) to 39% (95% CI, 32.0–46.4). Precision improved
with larger audit size and lower complication rates. However, precision was not meaningfully
improved by auditing >150 patients at a complication rate of 20% (95% CI 13.9%–27.3%),
nor >200 patients at a complication rate of 50% (95% CI 42.9%–57.1%).
Conclusion
Audit sizes should be 100 to 250 PIVCs per audit round depending on complication prevalence.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Infection, Disease & HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Peripheral venous catheters: an under-evaluated problem.Int J Antimicrob Agents. 2009; 34: S38-S42
- Comparative safety and costs of transparent versus gauze wound dressings in intravenous catheterization.J Nurs Care Qual. 2011; 26: 371-376
- Securement methods for peripheral venous catheters to prevent failure: a randomised controlled pilot trial.J Vasc Access. 2015; 16: 237-244
- Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial.Lancet. 2018; 392: 419-430
- Peripheral intravenous catheter non-infectious complications in adults: a systematic review and meta-analysis.J Adv Nurs. 2020; 77
- Audit of peripheral venous cannulae by members of an i.v. therapy forum.Br J Nurs. 2006; 15: 1244-1249
- Intravascular device use, management, documentation and complications: a point prevalence survey.Aust Health Rev. 2014; 38: 345-349
- Guidelines for the prevention of intravascular catheter-related infections.Am J Infect Contr. 2011; 39: S1-S34
- Short peripheral intravenous catheters and infections.J Infusion Nurs. 2012; 35: 230-240
- Peripheral intravenous catheter assessment: beyond phlebitis.Lancet Haematol. 2017; 4: e402-e403
- Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital.J Hosp Infect. 2007; 67: 22-29
- A practical handbook for clinical audit.Team NCGS, 2005
- Clinical audits to improve critical care: Part 1 Prepare and collect data.Aust Crit Care. 2018; 31: 101-105
- Clinical audits to improve critical care: part 2: analyse, benchmark and feedback.Aust Crit Care. 2018; 31: 106-109
- Proposed standards for the design and conduct of a national clinical audit or quality improvement study.Int J Qual Health Care. 2013; 25: 357-365
- Using audits as evidence.BJN. 2017; 2: S3
- Prevalence, risk factors, and outcomes of idle intravenous catheters: an integrative review.Am J Infect Contr. 2016; 44: e167-e172
- Audit and feedback: effects on professional practice and healthcare outcomes.Cochrane Database Syst Rev. 2012; : CD000259
- The hidden cost of clinical audit: a questionnaire study of NHS staff.Health Pol. 2000; 51: 181-190
- Infusion therapy standards of practice.J Infusion Nurs. 2016; 39
- epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.J Hosp Infect. 2014; 86: S1-S70
- 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult.Rev Española Quimioter. 2016; 29 (2016): 230-238
- Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide.J Hosp Med. 2018; 13: E1-E7
- Reducing healthcare costs facilitated by surgical auditing: a systematic review.World J Surg. 2015; 39: 1672-1680
- Australian commission on safety quality in health care. Quality framework for health care. In. Sydney, Australia.Aust Comm Safety Qual Health Care. 2010;
- WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care.World Health Organisation, Geneva2009
- Australian commission on safety and quality in health care. National hand hygiene initiative manual. In. Sydney, Australia.Aust Comm Safety Qual Health Care. 2019;
- The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation.BMJ Open. 2020; 10e035239
- Healthcare practitioner perspectives and experiences regarding vascular access device data: an exploratory study.Int J Healthc Manag. 2020; : 1-8
Article info
Publication history
Published online: March 29, 2021
Accepted:
March 3,
2021
Received in revised form:
March 1,
2021
Received:
December 21,
2020
Identification
Copyright
© 2021 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.
