The effect of simplifying peripheral intravenous cannulation packs and procedures on S. aureus bacteraemia rates: An interrupted time series analysis.
Tracks
Concurrent Stream 3
| Thursday, October 17, 2024 |
| 11:30 AM - 11:50 AM |
| Corinthian Room |
Overview
Lisa Kuhn
Speaker
A/prof Lisa Kuhn
Associate Professor In Nursing
ACU/Monash Health
The effect of simplifying peripheral intravenous cannulation packs and procedures on S. aureus bacteraemia rates: An interrupted time series analysis.
11:30 AM - 11:50 AMAbstract
Background
Peripheral intravenous catheter (PIVC) insertions are hazardous: they can cause Staphylococcus aureus bacteraemia (SAB), leading to patient distress and increased morbidity and mortality. The introduction of complex packs and credentialing procedures at our health service has previously resulted in an increased incidence of PIVC-associated SAB.
Aim
To evaluate PIVC insertion rates and the impact of simplified cannulation procedures on rates of PIVC-associated SAB in three adult Emergency Departments (EDs) over a 6.5-year period.
Methods
We conducted a retrospective cohort study using time series analysis of midpoint rate ratios of PIVC-associated SAB and PIVC insertions in adults (aged ≥18yrs) at three Monash Health EDs with a combined annual census of approximately 250,000 presentations from 1 January 2015 to 30 June 2023. Data on patient characteristics, total ED presentations and total PIVCs inserted in EDs were extracted from Electronic Medical Records. The Monash Infection Prevention and Infectious Diseases database provided data on PIVC-associated SAB infections. Stata V18 was used to conduct an interrupted time series analysis on data over the study period.
Results
A total of 1,406,469 patients presented to Monash Health EDs across the study period: approximately one in five adults (312,327 (22%)) had PIVCs inserted. There were 29 cases of PIVC-associated SAB (n=22 pre-intervention, n=7 post-intervention). The time series analysis demonstrated significantly reduced rates of PIVC-associated SAB following simplification of PIVC packs [PIVC-associated SAB per 10,000 ED presentations June 2018 vs June 2021 rate ratio, (95% CI), 0.33 (0.12, 0.92)] and unchanged PIVC insertion rates [PIVC insertions per 1,000 ED presentations June 2018 vs June 2021 rate ratio, (95% CI) 1.07 (0.97, 1.17)].
Conclusions
Simplified peripheral cannulation packs and procedures reduced the incidence of PIVC-associated SAB, with no change in PIVC insertion rates. Our study has served as a reminder to evaluate data for unintended consequences when changing practice.
Peripheral intravenous catheter (PIVC) insertions are hazardous: they can cause Staphylococcus aureus bacteraemia (SAB), leading to patient distress and increased morbidity and mortality. The introduction of complex packs and credentialing procedures at our health service has previously resulted in an increased incidence of PIVC-associated SAB.
Aim
To evaluate PIVC insertion rates and the impact of simplified cannulation procedures on rates of PIVC-associated SAB in three adult Emergency Departments (EDs) over a 6.5-year period.
Methods
We conducted a retrospective cohort study using time series analysis of midpoint rate ratios of PIVC-associated SAB and PIVC insertions in adults (aged ≥18yrs) at three Monash Health EDs with a combined annual census of approximately 250,000 presentations from 1 January 2015 to 30 June 2023. Data on patient characteristics, total ED presentations and total PIVCs inserted in EDs were extracted from Electronic Medical Records. The Monash Infection Prevention and Infectious Diseases database provided data on PIVC-associated SAB infections. Stata V18 was used to conduct an interrupted time series analysis on data over the study period.
Results
A total of 1,406,469 patients presented to Monash Health EDs across the study period: approximately one in five adults (312,327 (22%)) had PIVCs inserted. There were 29 cases of PIVC-associated SAB (n=22 pre-intervention, n=7 post-intervention). The time series analysis demonstrated significantly reduced rates of PIVC-associated SAB following simplification of PIVC packs [PIVC-associated SAB per 10,000 ED presentations June 2018 vs June 2021 rate ratio, (95% CI), 0.33 (0.12, 0.92)] and unchanged PIVC insertion rates [PIVC insertions per 1,000 ED presentations June 2018 vs June 2021 rate ratio, (95% CI) 1.07 (0.97, 1.17)].
Conclusions
Simplified peripheral cannulation packs and procedures reduced the incidence of PIVC-associated SAB, with no change in PIVC insertion rates. Our study has served as a reminder to evaluate data for unintended consequences when changing practice.
Biography
A/Prof Kuhn is an emergency nurse with extensive clinical, academic and research experience. Lisa uses quantitative, qualitative, mixed methods, implementation science and systematic reviews to research a broad range of issues including emergency care, heart disease and mental health. Lisa's research informs her service, teaching and supervision responsibilities, and provides an important nexus between research evidence and practice. She is the National Research and Research Training Coordinator for the School of Nursing, Midwifery and Paramedicine at Australian Catholic University and the Chair (Nursing) of the Monash Emergency Research Collaborative (MERC) at Monash Health.
