1. Alexander, Mary BS, CRNI

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FIGURE. Mary Alexand... - Click to enlarge in new windowFIGURE.

At INS' 30th Anniversary Annual Meeting in Nashville last year, we included in our roster of educational sessions a presentation on hand hygiene. Afterward, some attendees said that they were surprised that we would include a session on such a basic topic. But others expressed appreciation, saying that they were discouraged at the way many of the most basic techniques, such as antisepsis, hand hygiene, and safety, are bypassed or ignored in the workplace. True, the pace of daily rounds, patient acuity, and number of patients has been increasing steadily. But how many of us have cut corners now and then on the basics because they have simply become so routine that we perform them without thinking?


Although hand hygiene is a fundamental part of everyday practice, the CDC Guideline on the subject-a 40-page document released in October 2002-further demonstrates the importance of this practice. The CDC observed that hand hygiene frequency varies widely among hospitals, as does the length of time spent on hand washing. When this Guideline was released, all nurses could agree on some of the top reasons cited for lack of adherence to hand hygiene-insufficient time and understaffing.


Yet hand hygiene is not the only fundamental practice with which we need to be concerned. Some of the basics for infusion professionals, such as insertion site preparation, are prone to slip-ups. The few steps involved in preparing a venipuncture site have a significant impact on catheter-associated infections. INS fields many questions about insertion site dressing changes. As the cost of healthcare continues to rise, many facilities are asking how few dressing changes will maintain the catheter while keeping the infection rate down. While INS does not dictate (but rather, recommends) dressing change intervals in the Infusion Nursing Standards of Practice, we still advocate for a consistent policy and procedure to ensure that every patient with a vascular access device will have the least chance of developing complications. Taking time to perform the basics thoroughly will save time, expense, and patient discomfort later.


In addition to consistency in basic procedures, infusion professionals should beware of using infusion products in a way that is not in accord with the manufacturer's recommendations and instructions. Deviating from instructions or "off-label" use is a risky proposition: If a patient develops a complication, there is no rationale to fall back on for an alternative use of the product.


One of the best ways to observe the basics diligently is through the education of both patients and staff. Through education, we are held to a higher standard because we must set an example. Teaching a patient about proper catheter site care-but then using our own shortcuts-leads to inconsistency, a lesser level of care, and possibly complications. I am proud to know that infusion professionals call and write to INS for advice on the basics, showing that they are aware of their importance. But I also hope that infusion nurses are comfortable educating colleagues and insisting on compliance in this area. In the frenetic pace of today's healthcare system, it is easy to see how lapses occur. Humbling as it can be, let us not forget that our patients look to us to set the standard in providing the best infusion care.