Abstract
Background: Peripheral intravenous catheter (PIVC)-induced thrombophlebitis is a common complication that poses significant healthcare challenges, particularly in resource-limited settings where access to sterile equipment can be a challenge. This study aimed to enhance hand hygiene practices and improve the overall management of PIVCs in a secondary care hospital in southern India, with the goal of reducing the incidence of thrombophlebitis.
Methods: A quality improvement approach was adopted using a Plan-Do-Study-Act (PDSA) cycle to implement structured interventions. These interventions included staff training on hand hygiene, PIVC insertion techniques, and adherence monitoring. Data were collected through direct observations of clinical practice, along with pre-and post-intervention assessments. Paired t-tests were employed to evaluate the statistical significance of changes in compliance rates across the study period.
Results: Initial improvements in hand hygiene practices were noted, but compliance remained suboptimal throughout the study period. Statistically, significant improvements were achieved in workspace preparation, PIVC insertion techniques, and skin disinfection protocols. The incidence of PIVC-induced thrombophlebitis decreased over time, indicating the potential benefits of the interventions in reducing infection rates.
Conclusion: While the implemented interventions successfully enhanced technical skills and procedural adherence, the persistence of low hand hygiene compliance highlights a critical area for further improvement. Continuous education, monitoring, and reinforcement of hand hygiene practices are essential to ensure sustainable improvements in PIVC management and overall patient outcomes.
Keywords: thrombophlebitis, peripheral intravenous catheter, hand hygiene, sterility, quality improvement, resource-limited settings
References
- Zingg W, Barton A, Bitmead J, et al.: Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. Infect Prev Pract. 2023, 3:100271. 10.1016/j.infpip.2023.100271
- Ray-Barruel G, Polit DF, Murfield JE, Rickard CM: Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract. 2014, 20:191-202. 10.1111/jep.12107
- Lipe DN, Afzal M, King KC: Septic Thrombophlebitis. In. StatPearls [Internet, Treasure Island (FL): StatPearls Publishing; 2024202414.
- Mandal A, Raghu K: Study on incidence of phlebitis following the use of pherpheral intravenous catheter . J Fam Med Prim Care. 2019, 30:2827-31. 10.4103/jfmpc.jfmpc_559_19
- Milutinović D, Simin D, Zec D: Risk factor for phlebitis: a questionnaire study of nurses’ perception . Rev Lat Am Enfermagem. 2015, 23:677-84. 10.1590/0104-1169.0192.2603
- Abolfotouh MA, Salam M, Bani-Mustafa A, White D, Balkhy HH: Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Ther Clin Risk Manag. 2014, 8:993- 1001. 10.2147/TCRM.S74685
- Malm D, Rolander B, Ebefors EM, Conlon L, Nygårdh A: Reducing the Prevalence of Catheter-Related Infections by Quality Improvement: Six-Year Follow-Up Study. Open J Nurs. 2016, 6:79-87. 10.4236/ojn.2016.62008
- Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S: Quality Improvement Initiative to Reduce Intravenous Linerelated Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med PeerRev Off Publ Indian Soc Crit Care Med. 2021, 25:557-65. 10.5005/jp-journals-10071-23818
- Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE: Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014, 23:290-8. 10.1136/bmjqs 2013-001862
- Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part I: peripheral catheters [Internet]. [cited. . https://policycommons.net/artifacts/12375001/guidelines-for-the-prevention-of-bloodstreaminfectionsand-other-infect. https://www.who.int/publications/i/item/9789240093829.
- Høvik LH, Gjeilo KH, Lydersen S, et al.: Monitoring quality of care for peripheral intravenous catheters; feasibility and reliability of the peripheral intravenous catheters mini questionnaire (PIVC-miniQ). BMC Health Serv Res. 2019, 5:636. 10.1186/s12913-019-4497-z
- your-5-moments-for-hand-hygiene-poster.pdf [Internet]. [cited . . https://cdn.who.int/media/docs/defaultsource/integrated-health-services-/infection-prevention-andcontrol/your-5-mom. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-andcontrol/your-
- Hand hygiene tools and resources [Internet]. [cited . https://www.who.int/teams/integratedhealthservices/infection-prevention-control/hand-hygiene/training-tools..
- Tzolos E, Salawu A: Improving the frequency of visual infusion phlebitis (VIP) scoring on an oncology ward . BMJ Qual Improv Rep. 2014, 12:205455-2364. 10.1136/bmjquality.u205455.w2364
- Kuş B, Büyükyılmaz F: Visual Infusion Phlebitis Assessment Scale: Study of Independent Inter-Observer Compliance. Florence Nightingale Hemşire Derg. 2018, 26:179-86. 10.26650/FNJN296258
- Singh A, Barnard TG: Health Science Students’ Perceptions of Hand Hygiene Education and Practice in a South African University: Introducing the University Hand Hygiene Improvement Model. Healthcare. 2023, 15:2553. 10.3390/healthcare11182553
- Chakma SK, Hossen S, Rakib TM, et al.: Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital. Heliyon. 2024, 15:27286. 10.1016/j.heliyon.2024.e27286
- Tantum LK, Gilstad JR, Bolay FK, et al.: Barriers and Opportunities for Sustainable Hand Hygiene Interventions in Rural Liberian Hospitals. Int J Environ Res Public Health. 2021, 14:8588. 10.3389/fpubh.2022.968231
- O’Grady NP, Alexander M, Burns LA, et al.: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis Off Publ Infect Dis Soc Am. 20111, 52:162-93. 10.1086/344188
- Lambe K, Lydon S, McSharry J, et al.: Identifying interventions to improve hand hygiene compliance in the intensive care unit through co-design with stakeholders. HRB Open Res. 2021, 16:64. 10.12688/hrbopenres.13296.2
Corresponding Author
Dr. Sandra Sony
ASHWINI- Gudalur Adivasi Hospital, Kothervayal, Gudalur, Nilgiris, Tamil Nadu, India