The US Centers for Disease Control and Prevention (CDC) and The Infusion Nurses Society (INS) agree that vascular access device (VAD) dressing integrity is a critical factor for the prevention of hospital acquired infection. Michelle DeVries, BS, MPH, CIC, VA-BC, Senior Infection Control Officer at Methodist Hospitals, Indiana, reviews current practice guidelines, the emerging literature, and her facility’s successful quality improvement initiative for PIV dressing integrity in a 60‐minute educational webinar available here. In this blog, we’ll provide the highlights of her presentation.
Clean, dry, intact VAD dressings are important
The 2016 Infusion Therapy Standards of Practice recommendation that VAD dressing changes occur immediately should the dressing become loose or dislodge.1 Similar language can be found in the 2011 CDC Guidelines for the Prevention of Intravascular Catheter Related Infections, recommending catheter site dressing changes if the dressing becomes damp, loosened or visibly soiled.[2]
Intact dressings matter. Data indicate that VAD dressing disruption is a major risk factor for catheter-related bloodstream infections. In a 2012 study, the risk of major catheter‐related infection and catheter‐related bloodstream infection increased by more than 3‐fold after the second dressing disruption and by more than 10‐fold if the final dressing was disrupted.[3]
These data suggest that immediately, aggressively addressing loose or dislodged VAD dressings simply isn’t enough – for infection prevention, it is important to prevent dressing dislodgement and protect dressing integrity in the first place.
The importance of securing the dressing
Recent data indicate that VAD dressings, even top performing advanced dressings, fall far short of the recommended 5 to 7 days to first dressing change. A 2016 study evaluating four commercially available CVC dressings found that the median duration for the best performing dressing was less than 3 days.[4]
In real life practice, tape is often used to provide additional dressing securement. However, the use of tape is not recommended in any practice guideline. INS standards state that the use of tape should be avoided, as rolls of nonsterile tape can become contaminated with pathogenic bacteria.[1]
Quality Improvement Initiative for peripheral IV (PIV) dressings
Michelle and her team have made dressing integrity a major priority in their organization. Prevalence rounds to review dressings on all units, and documenting whether they are intact, lifted, reinforced, or if there is an exposed insertion site have allowed them to establish baseline data, which revealed room for improvement. A review of 2016 data for their institution revealed that 25% of bloodstream infections had documentation that the VAD dressing had been reinforced or prematurely changed. Repeated point prevalence (direct observation) studies showed that 45% of peripheral IV (PIV) dressings were reinforced, lifted or completely disrupted and 15% had an exposed insertion site.
The stated goal at the start of the initiative was to achieve 80% of dressings remaining fully intact (at all four corners without reinforcement) until device removal or 7‐day dressing change.
The quality improvement project involved 4 different configurations for PIV dressings:
1. No change in PIV kit (Current kit), with extensive education provided
2. Updated dressing (Dressing #2)
3. Dressing #1 plus Mastisol® liquid gum mastic adhesive
4. Dressing #2 plus Mastisol® liquid gum mastic adhesive
The results were as follows:
| Fully Intact | Insertion Site Exposed | |
| Baseline (Current kit) | 55% | 15% |
| Current kit + Education | 57% (74/134) | 15% (20/134) |
| Updated dressing (#2) alone* | 9%* (1/11) | 27% (3/11) |
| Dressing #1 (2‐part securement dressing) + Mastisol | 93% (26/28) | 0% |
| Dressing #2 (2‐part securement dressing) + Mastisol | 83% (19/23) | 0% |
*Evaluation halted based on initial findings
Bundle to optimize insertion, care, maintenance and success of PIVs
Michelle shares the PIV bundle that led to success in the quality improvement initiative, now used hospital‐wide:
Insertion
• CHG skin prep
• Sterile gloves if repalpating the site
• Alcohol caps for intraluminal protection
• CHG impregnated sponge for extraluminal
protection
• Updated catheter‐integrated extension set
• Bordered (securement) dressing
• Neutral connectors
• **New addition 2017 – Mastisol liquid
adhesive with dressing placement
Additionally, Detachol® adhesive remover and individual Mastisol® vials are now stocked separately in unit supply rooms throughout the hospital. Starting in August 2017, premade PIV kits were stocked and by mid‐September, over 5000 kits had been issued. Based on regular consultation with her institution’s wound ostomy continence nurses, Michelle reports that zero skin tears have been reported since inclusion of Mastisol® in the PIV kits.
The experience at Michelle’s institution indicates that it can be done – well maintained VAD dressings without a roll of tape.
For more information about Mastisol® or information on Vascular Access Dressing Adherence Point Prevalence Assessments, please contact your sales consultant or Eloquest Healthcare®, Inc., call 1‐877‐433‐7626 or visit www.eloquesthealthcare.com.
Minimizing infection risk is an essential part of optimizing “The Triple Aim” of the Affordable Care Act. Eloquest Healthcare is committed to providing solutions that can help you reduce the risk of conditions like a central line‐associated bloodstream infection (CLABSI) and post‐operative wound contamination.
References:
1. Infusion Therapy Standards of Practice. J Infus Nurs. 2016;39:1S ISSN 1533‐1458.
2. O’Grady NP, Alexander M, Burns LA et al. Guidelines for the Prevention of Intravascular Catheter‐Related
Infections, 2011. The US Centers for Disease Control and Prevention.
https://www.cdc.gov/infectioncontrol/guidelines/bsi/. Accessed July 31, 2018..
3. Timsit JF, Bouadma L, Ruckly S, et al. Dressing disruption is a major risk factor for catheter‐related infections. Crit
Care Med. 2012;40:1707‐14.
4. Richardson A, Melling A, Straughan C, et al. Central venous catheter dressing durability: an evaluation. J Infect
Prevent. 2015;16:256‐61.
