The purpose of this study was to evaluate the impact of practice and intravenous (IV) therapy product changes on central line infections (CLIs) and needlestick injuries. Data were collected in 2009 and 2010 for 1 year before and after implementation of practice and product changes. Statistical significance was noted when comparing CLIs before and after implementation of an antimicrobial IV connector. The number of needlestick injuries also decreased by 12% during this time. Study results support ongoing clinical practice monitoring and education as well as the use of a luer-activated IV therapy system and an antimicrobial IV connector.

In Ontario, Canada, needlestick injuries are reported to the Workplace Safety and Insurance Board. Hospitals track needlestick and sharps injuries through their respective departments of occupational health. During tracking/mandatory reporting of needlestick injuries, more needlestick injuries were noted from 2008 to 2009. It was determined that current practice in IV therapy had to be reevaluated.

A third party completed an IV therapy environmental scan. This scan addressed the following areas: clinical practice, product use, and the standardization of both practice and product across the organization. Based on the results, management made recommendations related to the use of luer-activated IV therapy products to decrease the risk of needlestick injuries among staff and patients. The use of an antimicrobial IV connector was suggested as a potential solution to reduce CLI rates further.

Other recommendations included, but were not limited to, a reduction in the number of IV sets used hospital-wide (patient safety initiative), the use of an IV extension set on saline locks (to decrease phlebitis and spontaneous disconnects), practice changes and prompts (eg, "scrub the hub"), education related to practice changes, and policy changes related to blood procurement.

STUDY DESIGN

The third-party environmental scan was completed in the fall of 2009. In February 2010, the hospital implemented both a luer-activated IV therapy system and antimicrobial IV connector. The IV therapy technologies were used throughout the patient care areas. Whereas the antimicrobial connector should not be used on patients with silver allergies, there were no patients during this time with documented allergies to silver. Product education was completed in 3 phases: before, during, and after product implementation. A staff satisfaction survey was completed at 1, 3, and 6 months after product implementation, and a practice audit was completed at 1, 3, 6, and 14 months after product implementation. Both needlestick injury rates and CLI rates were collected throughout the process.

EDUCATION

The third-party recommendations were (1) educating and auditing IV therapy practice on an ongoing basis to address past practices and (2) implementing new technology. Both the luer-activated IV therapy products, as well as the antimicrobial IV connector, were new technology to the hospital. A third-party registered nurse product specialist provided the stakeholders (nurses, physicians, and technicians) with demonstrations, in-service programs, and information booths.

Administrators, clinicians, and third-party registered nurse product specialists reinforced to staff that needles could not be used on luer-activated IV therapy products, and although an antimicrobial IV connector may help in the reduction of CLIs, it is still important to "scrub the hub" as a part of best practice in IV therapy. Staff satisfaction with the technology was surveyed over time, with results indicating continued technology satisfaction. Audits of best practice indicated that practice changes had been maintained since the completion of product education. Where best practice was not maintained, the registered nurse product specialist would take the opportunity to educate when and where appropriate.

DATA COLLECTION

Since April 2009, CLI data have been reported publicly through the Ministry of Health and Long-Term Care patient safety indicators in Ontario, Canada. The CLI rate is determined on a monthly basis but is reported publicly online trimonthly. The CLI rate is determined by the number of newly diagnosed CLI cases that occur at least 48 hours after receiving a central line in an intensive care unit setting. The number of cases of CLI is then compared with the number of catheter-days in a month and, finally, multiplied by 1000.

Needlestick injuries reported to the Occupational Health and Safety Department were tracked on a monthly basis for one year before and after the implementation of a luer-activated IV therapy system. This was completed in conjunction with reporting to the Workplace Safety and Insurance Board. An analysis of the cause of needlestick injury and location of needlestick injury incidence was also recorded during this time.

RESULTS

A 2-tailed t test was completed to evaluate the effectiveness of the antimicrobial IV connector in comparison with previous practice. Statistical significance was noted when comparing CLIs before and after implementation of an antimicrobial IV connector. A P value of <.01 was determined via a 2-tailed t test.

TABLE 4 Potential Cost Savings Regarding Needlestick Injury at University of Ottawa Heart Institute

RECOMMENDATIONS

A luer-activated IV therapy delivery system can improve health care worker safety by decreasing needlestick injury rates. An antimicrobial IV connector can help decrease CLI rates if implemented in combination with IV therapy best practice education. Monitoring and education are critical and must be directly considered on an ongoing basis to ensure the maintenance of low infection and needlestick injury rates.

COST CONSIDERATIONS

TABLE 5 Variables

LIMITATIONS

Limitations of this study include the possibility that staff may not report needlestick injuries to Occupational Health and Safety, the small size of the organization, and that practice and product changes were made concurrently. It is not known whether the practice changes or the product changes had the greater impact on CLIs or needlestick injuries.

Future studies that look at a product change or practice change independently may best determine the impact of each change specifically.

DISCUSSION

The economic restraints of today's health care environment have created obstacles to implementing change. Complying with best-practice guidelines and ensuring the rollout of initiatives, such as SHN or "needle-free" legislation, do not always guarantee decreased infections and positive outcomes. Organizations need to complete environmental scans to ensure that the appropriate equipment is being used, and they need to audit their practice to ensure compliance, maintenance, and currency of such practices. Administrators should be made aware of the cost savings to justify the expense of innovative equipment and ongoing education.

Organizations must also ensure that practice is not driven by history and routines rather than research and evidence. Until there is a rise in infection rates or an adverse event that leads to an inquiry, practices are often completed in the same fashion. The saying "if it isn't broke, don't fix it" cannot be the mantra of health care. Addressing part of the issue often leads to disappointing results and later surface as symptoms of a bigger problem. Therefore, it is important to be proactive in quality improvement efforts.

ACKNOWLEDGMENTS

The author would like to thank Gillian Strudwick and Lynne Eisener for their consultation and involvement in this project.

REFERENCES

antimicrobial; catheter-related bloodstream infections; central line infections; IV connector; IV therapy; luer activated; needlestick injuries; nursing; split septum