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.^1,2

Russell Nassof, JD, founder of RiskNomics, discusses the importance of common sense in evidenced-based medicine, the issue of dressing disruption, the prominence of Medical Adhesive-Related Skin Injury, small evidence-based studies, and the potential legal and financial implications of dressing disruption in a 50-minute educational webinar available here. In this blog, we’ll provide the highlights of his presentation.

Evidence-Based Medicine

When treating patients, physicians need to not blindly rely upon Clinical Practice Guidelines, but rather use common sense and make changes when changes are needed. Evidence-based medicine relies upon clinical judgement and critical thinking, current scientific evidence and patient values and preferences to provide a high level of care.^3,4

Dressing Disruption and Risk of Infection

Both the CDC and Infusion Therapy Standards of Practice recommend that catheters be replaced if the insertion or dressing becomes damp, loosened, or visibly soiled.^1,2 In fact, dressing disruption is a major risk factor for catheter-related infections.⁵

One study demonstrated that only 3% of dressings lasted the entirety of their intended 7 days with a majority of dressings lasting less than 48 hours,⁶ and another study found that 67% of over 11,000 dressing changes were performed earlier than scheduled due to soiling or becoming non-adherent.⁵

MARSI

MARSI, or Medical Adhesive-Related Skin Injury, is a persistent issue in the medical space. MARSI is defined as an occurrence in which erythema or another manifestation of cutaneous abnormality persists for 30 minutes or more after the removal of a medical adhesive product.⁷ However, it should be noted that improved dressing integrity results in a decreased need for dressing changes and therefore a reduced risk of MARSI.⁸ Additionally, healthcare providers should consider the use medical adhesive removers to minimize skin discomfort and skin damage associated with removal of adhesive products.⁷

The Legal Argument

Today, more and more medical complications are deemed preventable, and the risk of a malpractice claim is higher. Healthcare providers must now ask themselves if a hospital-acquired infection (HAI) was at all preventable and if the standard of care was met.

What’s more, providers must also consider any products available to address the issues at hand and if using those products would have resulted in improved patient outcomes with minimal risk, liability, cost, and training.

As a whole, INS, CDC, and National Evidence-based Guidelines for preventing HAIs must be considered. The evidence from 4 small studies is :

Finances and Dressing Disruption

Cost reduction is associated with minimized dressing changes, each of which costs anywhere from $5 to $9.50.⁵ There is also a time-saving element due to fewer dressing changes,⁶ as well as the psychological savings that come from improved patient comfort.¹⁴

Incorporating clinical practice guidelines with evidence-based medicine is the best way to ensure that we are meeting the standard of care. Numerous studies have clearly indicated that the prevention of dressing disruption is pivotal in reducing the risk of infection. Using a product that enhances the potential for catheter dressings to remain adherent may assist clinicians in meeting evidence-based standards of care and decreasing the prevalence of CRBSIs, all while reducing costs and improving both patient and clinician satisfaction.

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.