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Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany

Point prevalence survey of peripheral venous catheter usage in a large tertiary care university... Background: Bloodstream infections (BSI) are among the most frequently documented healthcare-associated infections (HAI). Central and peripheral venous catheters (CVC and PVC) are relevant risk factors for BSI. Although the risk for BSI is higher for CVC, PVC are utilized more frequently and are therefore relevant in the context of HAI prevention. Robust data on the prevalence of PVC and associated infections in German hospitals are scarce to this date. The objectives of this survey were to estimate the prevalence of PVC and PVC-associated infections on peripheral wards of a large tertiary care hospital in Germany. The collected data may be utilized for a tailored infection prevention intervention in the future. Methods: A point prevalence survey was conducted on peripheral wards of a tertiary care hospital with more than 3.000 beds. Data were collected between August 2017 and February 2018. Standardized data collection forms were used for collecting ward, patient and PVC-related data. As endpoints, prevalence of patients with PVC, PVC- associated infections and PVC without usage in the 24 h prior to the survey and without documentation of intended usage in the 24 h after the survey (“unused PVC”) were chosen. For data analysis, Kruskal-Wallis test was employed for continuous variables and Chi-squared test or Fisher’s exact test for categorical variables. Multivariable analysis and logistic regression were performed for the endpoint unused PVC. Results: Data from 2.092 patients on 110 wards were collected. The overall prevalence of patients with PVC was 33%. Infections were recorded in 16 patients. Except one case of BSI, these were all local infections at the site of insertion. Of 725 documented PVC, 77 (11%) were unused PVC. Multivariate analysis and logistic regression revealed wards with the practice of regularly obtaining blood from PVC, PVC with dirty or loose insertion dressing, pediatric ward specialty and last inspection of the PVC more than 1 day ago as significant risk factors for unused PVC. Conclusions: A substantial proportion of patients presented with a PVC on the day of survey. Too few infections were recorded to allow for more detailed analyses. Various risk factors for unused PVC were identified. We hereby present a solid method to obtain an overview about PVC use and to increase awareness for PVC-associated risks. The limitations of point prevalence surveys have to be recognized. Keywords: Infection control, Bloodstream infection, Sepsis, Phlebitis, Peripheral venous catheter, Healthcare- associated infection, Point prevalence survey * Correspondence: seven-johannes-sam.aghdassi@charite.de Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 2 of 7 Background were collected for all patients, which presented with a Healthcare-associated infections (HAI) are a challenge in PVC on the day of survey as well as for patients with an the practice of modern medicine. The prevalence of HAI active PVC-associated infection, even if the PVC had in patients hospitalized in German acute care hospitals has already been removed on the day of survey. An active in- been estimated to be approximately 4.6% [1]. A relevant fection was defined either as fulfilling case definitions on portion of these infections are device-associated [2, 3]. For the day of survey or as having fulfilled case definitions bloodstream infections (BSI) the most important risk fac- prior to the survey and still receiving treatment for the tor is the use of central venous catheters (CVC) and infection, even if symptoms of the infection were no lon- peripheral venous catheters (PVC). The risk for BSI per ger present. On the PVC level, the date of insertion, the PVC is lower than per CVC, whereas the application rate insertion site, the size of the PVC by Birmingham gauge of PVC is substantially higher [4, 5], as PVC represent one (G), the kind and condition of the insertion dressing, the of the most frequently used medical devices in hospitals last usage of the PVC before the survey and the intended [6–8]. Estimations of prevalence rates for PVC range from next usage after the survey, whether a catheter extension 24 to 100% across different countries [8]. In Germany, set was used, which is recommended by the German there is a lack of robust published prevalence data con- Commission for Hospital Hygiene and Infection Preven- cerning PVC use in hospitals. Furthermore, only recently tion [12], and indicators concerning PVC documentation has the collection of data on PVC utilization been intro- were collected. For more details, please find the translated duced as a part of the German national surveillance net- questionnaires in the Additional file 1. work (Krankenhaus-Infektions-Surveillance-System, KISS). The aims of this survey were to estimate the preva- Data collection lence of PVC and PVC-associated infectious complica- The prevalence survey was conducted on 110 peripheral tions, and to assess indicators of PVC management on wards of the Charité-University Medicine Hospital. Inten- all wards in a tertiary care university hospital, as a prep- sive care units, intermediate care units and outpatient set- aration for a tailored infection control intervention to tings were excluded from the survey. From August 2018 optimize PVC use and management. to February 2018 the data collection was executed by a single infection control nurse supervised by two infection Methods control physicians. The point prevalence survey was conducted on peripheral wards of all three campuses of the Charité-University Statistical analysis Medicine Hospital in Berlin, Germany, a tertiary care Univariable and multivariable analysis were used to com- university hospital with more than 3.000 beds and about pare two groups. Data was subjected to univariable ana- 150.000 inpatient cases per year. lysis using Kruskal–Wallis-test for continuous data and Chi-squared test for categorical data. When necessary, Questionnaire Fisher’s exact test was used instead of Chi-squared test. In Standardized data collection forms were designed to addition, data were analyzed by logistic regression for the collect ward, patient and PVC data. On the ward level, outcome whether PVC were still in use (i.e. usage within the handling of PVC was assessed through a standard- the 24 h prior to the survey and/or documented intended ized questionnaire to be answered by the head of nurs- use in the 24 h after the survey). The following covariates ing of the respective ward. Among the data collected were included: at the ward level: ward specialty, number were questions exploring which professional groups of beds, percentage of occupied beds, prevalence of were generally responsible for PVC insertion, whether patients with PVC on the ward, regular blood sampling PVC were used to draw blood, and whether a catheter via catheter, regular use of a catheter extension set; at the extension set was regularly used. The use of such catheter patient level: age, sex, time span between admission to the extension sets has been promoted by the local hospital hospital and survey, time span between admission to the infection control team in recent years. On the patient ward and survey, ASA score; on the PVC level: size of level, age, sex, the Physical Status Classification of the PVC, use of a catheter extension set, anatomic location of American Society of Anesthesiologists (ASA) score [9], the PVC insertion site, condition of dressing, and time thenumberofinsertedPVC at thetimeofsurveyand span between last inspection and survey. Covariates PVC-associated infections were recorded. Phlebitis was were selected by forward backward selection and in- evaluated according to the Visual Infusion Phlebitis Score cluded in the model if p = 0.05 and excluded from the [10], other PVC-associated infections were defined ac- model if p >0.10. A p-value of less than 0.05 was con- cording to the definitions used in the German KISS [11], sidered significant. Only 696 datasets were included in which are based on the definitions of the United States the logistic regression, 29 datasets were excluded be- National Healthcare Safety Network. Patient-related data cause of missing values. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 3 of 7 All analyses were performed using R 3.4.3 (R Foundation Table 1 Patient and peripheral venous catheter-related data for Statistical Computing, Vienna, Austria) and SAS 9.4 Parameter Number (percentage) (SAS Institute Inc., Cary, NC, USA). Patients, total 687 Ethical approval Sex male 360 (52) All data were anonymized and collected in accordance Age in years 57 to paragraph 23 of the German federal law, German Pro- ASA score 2.7 tection against Infection Act (“Infektionsschutzgesetz”), Days of hospitalization until survey 4 which regulates the prevention and control of infectious Patients with ≥ 1 PVC 681 diseases in humans. Therefore, ethical approval and in- PVC, total 725 formed consent were not required. Patients with PVC-related infection(s) 16 Results PVC with catheter extension set 309 (43) Data from 2.092 patients in 110 wards were collected Site of insertion between August 2017 and February 2018. 681 of these back of hand 267 (37) patients had one or more PVC on the day of survey. The forearm 245 (34) overall PVC prevalence was found to be 33% with sub- upper arm incl. elbow 204 (28) stantial differences between wards. Figure 1 illustrates the differences in PVC prevalence between wards. Insertion of other 9 (1) PVC was reported by all wards to be done primarily by Size of PVC by Birmingham gauge (G) medical doctors or students of medicine. In 58 wards G24/G22 136 (19) (53%) PVC were regularly or occasionally used to obtain G20/G18 558 (77) blood samples from patients. A catheter extension set was G16/G14 31 (4) reported to be regularly used in 51 (46%) wards. Transparent insertion dressing 725 (100) Patient-related data were collected for a total of 687 patients. The data are summarized in Table 1. Infections Dressing loose or dirty 87 (12) were recorded in 16 patients. Ten (63%) of these pa- Days from insertion until survey 2 tients had a PVC on the day of survey. In four patients, Last usage before survey in hours 7.2 the infection was associated with a PVC that was still No documented usage in 24 h prior and 77 (11) present on the day of survey. In all other cases, the PVC after survey related to the infection had already been removed (n =6) Catheter insertion documented in 629 (87) or had been removed and a new PVC was placed at a patient charts different site (n = 6). The presence of only local signs of PVC inspected by ward staff on the day 441 (61) of survey or day before ASA Physical Status Classification of the American Society of Anesthesiologists, a b PVC peripheral venous catheter(s); mean; median infections at the site of insertion were reported in 15 pa- tients. Four of these patients received conservative local treatment (incl. Cooling and immobilization). In one patient, a PVC-related thrombophlebitis as well as a PVC-related BSI (fulfilling the KISS-definitions for primary sepsis) were recorded. Staphylococcus aureus was identified as the causing pathogen. The patient received antimicrobial treatment. Data on a total of 725 PVC in 681 patients were collected (Table 1). Nine (1%) of 725 PVC showed signs of infection such as pain, induration, redness, and swelling. No visual phlebitis score higher than two was recorded in the survey. Univariable analysis focusing on risk factors for PVC without usage in the 24 h prior and after the survey Fig. 1 Prevalence of patients with peripheral venous catheters per (referred to as “unused PVC”) revealed pediatric ward ward. Scatter plot of prevalence of patients with peripheral venous specialty, the practice of regularly using PVC for blood catheters (PVC) per ward sampling, small size of the PVC, bad condition of the Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 4 of 7 insertion site dressing as well as a long interval since Logistic regression as illustrated in Table 3 revealed that last inspection as significant risk factors of unused patients in pediatric wards had a significantly higher risk of PVC. The use of a catheter extension set was identified having an unused PVC than patients in medical wards. Dif- as decreasing the likelihoodofunusedPVC (Table 2). ferences were also found when comparing medical wards Table 2 Univariable analysis of risk factors for peripheral venous catheters without usage in the 24 h prior and after survey PVC with usage (n = 627) PVC without usage (n = 69) p-value number (percentage) number (percentage) PVC regularly used for blood sampling on ward 373 (59) 59 (86) < 0.05 Regular use of catheter extension set on ward 331 (53) 19 (28) < 0.05 Ward specialty < 0.05 Medical 307 (49) 20 (29) Surgery 119 (19) 16 (23) Other surgery 134 (21) 17 (25) Interdisciplinary/other 38 (6) 8 (12) Pediatrics 29 (5) 8 (12) Number of beds on ward > 22 (median) 303 (48) 28 (41) 0.27 Percentage of occupied beds per ward (mean) 88.6 88.6 0.94 Prevalence of patients with PVC on ward (mean) 43.5 44.2 0.58 Sex, male 331 (53) 33 (48) 0.51 Age (in years) 0.86 0–18 32 (5) 4 (6) 19–35 90 (14) 12 (17) 36–55 119 (19) 10 (14) 56-70 178 (28) 19 (28) > 70 208 (33) 24 (35) Hospital stay > 7 days 168 (27) 14 (20) 0.30 Stay on ward > 7 days 121 (19) 10 (14) 0.41 ASA score 0.09 1–2 130 (21) 21 (30) 3–5 497 (79) 48 (70) Insertion site 0.34 Back of hand 225 (36) 30 (43) Forearm 211 (34) 25 (36) Upper arm incl. elbow 186 (30) 14 (20) Other 5 (1) 0 (0) Size of PVC by Birmingham gauge (G) < 0.05 G24/G22 126 (20) 5 (7) G20/G18 477 (76) 59 (86) G16/G14 24 (4) 5 (7) Dressing loose or dirty 65 (10) 20 (29) < 0.05 Days since last inspection < 0.05 0 213 (34) 2 (3) 1 394 (63) 46 (67) > 1 20 (3) 21 (30) PVC with catheter extension set 292 (47) 19 (28) < 0.05 a b c PVC peripheral venous catheter(s); incl. internal medicine, dermatology, neurology, geriatrics; traumatology and abdominal surgery; incl. urology, gynecology, otolaryngology Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 5 of 7 Table 3 Logistic regression model of risk factors for peripheral common invasive procedures in hospitals [6, 15, 16]. The venous catheters without usage in the 24 h prior and after survey BSI infection rate per 1.000 PVC device-days is estimated Odds Ratio p-value to be around 0.6 (95CI 0.2–0.9) [17]. Therefore, due to the (95%-confidence interval) frequency of application and severity of possible complica- PVC regularly used for blood sampling on ward < 0.05 tions the topic gains very high relevance from a public No reference health perspective. A substantial proportion of PVC were identified as un- Yes 3.37 (1.60–7.10) used PVC on the day of survey. On wards, where the Days since last inspection < 0.05 healthcare personnel regularly obtained blood from PVC, 2–8 reference a significantly higher number of unused PVC were re- 0 0.01 (0.00–0.04) corded. These unused PVC were less likely to be inspected 1 0.13 (0.06–0.28) on the day of survey or the day before and therefore can Ward specialty < 0.05 be regarded as an unnecessary infection risk for the pa- tient in two respects: first, the mere presence of an inva- Medical reference b sive device that might no longer be needed; second, the Surgery 1.26 (0.57–2.74) lack of inspection of the device. Our method of data Other surgery 1.32 (0.62–2.84) collection did not allow for differentiating whether an Interdisciplinary/other 2.08 (0.77–5.64) inspection, that was carried out, was simply not docu- Pediatrics 10.41 (2.71–40.07) mented or whether no inspection was undertaken in the Condition of insertion dressing < 0.05 first place. Both possibilities, however, illustrate the need for improving systematic PVC management and Dirty or loose reference documentation. The fact that multivariable analysis Well-maintained 0.25 (0.13–.0.48) revealed a loose or dirty (i.e. not well-maintained) in- PVC peripheral venous catheter(s); incl. internal medicine, dermatology, b c sertion dressing to be a risk factor for unused PVC, neurology, geriatrics; traumatology and abdominal surgery; incl. urology, gynecology, otolaryngology corroborates this result. It remains unclear whether the high number of unused to wards of other specialties, however, these were not sig- PVC (as defined by the above-stated criteria) were sim- nificant. Furthermore, logistic regression identified patients ply forgotten by the ward staff or intentionally remained on wards, where PVC were regularly used for obtaining inserted to be available in case the patient’s condition blood samples to have a significantly higher risk of having changed, and an intravenous application of fluids or an unused PVC, than patients on wards where PVC are medication became necessary again. The practice of rarely or never used for drawing blood. A dirty or loose leaving PVC inserted “just in case” is a phenomenon that insertion dressing was revealed to be a significant risk factor was previously described by other authors [18–20]. for unused PVC by multivariable analysis. Inspection on These studies and our data emphasize the importance the day of survey or within the 24 h prior significantly of a daily, systematic, and documented inspection of reduced the risk for unused PVC when compared with PVC which should be an integral part of good clinical inspection more than 2 days before the survey. practice [12, 21]. Education and feedback of PVC-related surveillance Discussion data or topics have frequently been cited as effective We analyzed data of over 2.000 patients. Approximately intervention strategies to improve PVC use and manage- one in three patients (681) presented with one or more ment [21–23]. However, the basis of education and feed- PVC on the day of the point prevalence survey. A simi- back are information such as the data collected in the lar prevalence was reported in a study in the United present survey. This kind of data collection is intensive Kingdom by Reilly et al. [13]. In our survey too few in- in time and personnel expenditure. Other intervention fections were recorded to allow for detailed analyses of strategies such as checklists or daily reminder systems risk factors. In total, PVC-related infectious complica- may be effective as well, and easier to establish [24–26]. tions were found in very few of the recorded PVC. Interestingly, multivariate analysis revealed that the Except one case of PVC-related BSI, these were all local practice of regularly using catheter extension sets signifi- infections, ranging from redness and swelling to signs of cantly decreased the probability of unused PVC. This thrombophlebitis. These findings indicate that PVC at our can be seen as an indicator that wards which have a high hospital, from the perspective of an individual patient, educational level with regard to PVC management are pose a low risk for catheter-related BSI or other severe in- more likely to realize timely catheter removal, thus, fectious complications. Other studies have yielded similar demonstrating the efficacy of the above-mentioned inter- results [14]. The insertion of PVC is one of the most vention strategies. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 6 of 7 Patients in pediatric wards were identified by multivari- factors. Some of these factors appear to be structural or able analysis to have a significantly higher risk for unused organizational, such as the practice of regularly using PVC than patients in medical wards. This is especially PVC for obtaining blood samples. It appears that PVC critical since these patients represent a particularly vulner- may remain inserted longer because of convenience rea- able population. Univariate analysis showed that smaller sons, thereby putting patients at an unnecessary risk for PVC (G24/G22) were a risk factor for unused PVC as well. PVC-related complications. Lower frequency of PVC Since smaller PVC are inserted more frequently in inspection seems to contribute to this negative effect. pediatric wards, this finding can be interpreted as a conse- Feasible intervention strategies generated from the data quence of the effect of the ward specialty. presented here, may be to feed back the data to clini- Point prevalence surveys provide a solid method to cians and relevant stakeholders, to organize targeted obtain an overview and to identify areas of potential im- education and training programs and to develop check- provement. Importantly, it has to be recognized that this lists and reminder systems to decrease the number of method entails relevant limitations. Among these are: unnecessary PVC and device-days. Only PVC present at the time of survey were Additional file recorded. PVC which may have been present in the Additional file 1: PVC_survey_questionaires_english_version. (DOCX 14 days before conducting the survey and which had kb) been removed before data collection were not recorded. Therefore, we cannot make an accurate Abbreviations statement on the frequency of PVC usage. ASA: American Society of Anesthesiologists; BSI: Bloodstream infection(s); Only PVC-associated infections which were active at CVC: Central venous catheter(s); G: Birmingham gauge; HAI: Healthcare- associated infection(s); KISS: Krankenhaus-Infektions-Surveillance-System; the time of survey were recorded. Infections occur- PVC: Peripheral venous catheter(s) ring before or after the survey could not be recorded with the methodology applied. Furthermore, patients Acknowledgements Not applicable. with severe infectious complications, such as BSI, may have been transferred to intensive care units. Funding Since data collection was conducted on peripheral The study was not funded. wards only, such infections would have been missed. Availability of data and materials Therefore, accurate estimations on the burden of The datasets used and analyzed in the context of this survey are available PVC-associated infections are not possible with the from the corresponding author upon reasonable request. data collected in the survey present. Authors’ contributions Ward data was collected through a systematic SA, FS, and PG organized the initial study design and development. DG, SA questionnaire to be answered by the head nurse. and FS led the data collection. CS conducted the statistical analysis with input from SA and FS, who also drafted the manuscript. PG has made These answers may be subjective in some cases. essential contributions to the interpretation of the data and to the Reluctance by ward staff to collect microbiological preparation of the manuscript. All authors approved the final version of the specimen in case of suspected infection may lead to manuscript. an underestimation of PVC-related infections. Ethics approval and consent to participate The present survey is a single-center survey and Not applicable, because all data were surveillance-based data which were cannot be used for extrapolations on a national level. obtained in accordance with the German Protection against Infection Act (“Infektionsschutzgesetz”). Patients with longer hospital stays are generally overrepresented in point prevalence surveys. Consent for publication Not applicable, because all data were surveillance-based data which were obtained in accordance with the German Protection against Infection Act A strength of the survey is that it represents a true (“Infektionsschutzgesetz”). cross-section of the included peripheral wards of our hospital since all patients of these wards were assessed. Competing interests All data were collected by a single infection control The authors declare that they have no competing interests. nurse, experienced and well-trained in aspects of surveil- lance and data collection. We thereby were able to re- Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in duce inter-rater bias to a minimum. published maps and institutional affiliations. Conclusion Author details Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Our survey demonstrated that the duration of insertion Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of PVC is not only determined by how long they are 2 of Hygiene and Environmental Medicine, Berlin, Germany. National utilized for intravenous application, but also by other Reference Center for the Surveillance of Nosocomial Infections, Berlin, Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 7 of 7 Germany. Institute for Infection Prevention and Hospital Epidemiology, 19. Barlow GD, Palniappan S, Mukherjee R, Jones MC, Nathwani D. Unnecessary Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, peripheral intravenous catheterisation on an acute medical admissions unit: Germany. a preliminary study. Eur J Intern Med. 2002;13:380–4. 20. Goddard L, Clayton S, Peto TEA, Bowler ICJW. The ‘just-in-case venflon’: Received: 17 October 2018 Accepted: 9 January 2019 effect of surveillance and feedback on prevalence of peripherally inserted intravascular devices. J Hosp Infect. 2006;64:401–2. 21. Boyd S, Aggarwal I, Davey P, Logan M, Nathwani D. Peripheral intravenous catheters: the road to quality improvement and safer patient care. J Hosp References Infect. 2011;77:37–41. 1. Behnke M, Aghdassi SJ, Hansen S, Diaz LAP, Gastmeier P, Piening B. The 22. Fakih MG, Jones K, Rey JE, Takla R, Szpunar S, Brown K, et al. Peripheral prevalence of nosocomial infection and antibiotic use in German hospitals. venous catheter care in the emergency department: education and Dtsch Arztebl Int. 2017;114:851–7. feedback lead to marked improvements. Am J Infect Control. 2013;41:531–6. 2. Vincent J-L, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin M-H, 23. Frigerio S, Giulio PD, Gregori D, Gavetti D, Ballali S, Bagnato S, et al. et al. The prevalence of nosocomial infection in intensive care units in Managing peripheral venous catheters: an investigation on the efficacy of a Europe: results of the European prevalence of infection in intensive care strategy for the implementation of evidence-based guidelines. J Eval Clin (EPIC) study. JAMA. 1995;274:639–44. Pract. 2012;18:414–9. 3. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for 24. Fasugba O, Cheng AC, Russo PL, Northcote M, Rosebrock H, Mitchell BG. nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40. Reducing urinary catheter use: a protocol for a mixed methods evaluation 4. Rickard CM, Webster J, Wallis MC, Marsh N, McGrail MR, French V, et al. Routine of an electronic reminder system in hospitalised patients in Australia. BMJ versus clinically indicated replacement of peripheral intravenous catheters: a Open. 2018;8:e020469. randomised controlled equivalence trial. Lancet. 2012;380:1066–74. 25. Youngerman BE, Salmasian H, Carter EJ, Loftus ML, Perotte R, Ross BG, et al. 5. Ahlqvist M, Berglund B, Nordstrom G, Klang B, Wirén M, Johansson E. A new Reducing indwelling urinary catheter use through staged introduction of reliable tool (PVC assess) for assessment of peripheral venous catheters. J electronic clinical decision support in a multicenter hospital system. Infect Eval Clin Pract. 2010;16:1108–15. Control Hosp Epidemiol. 2018;39:902–8. 6. Wong K, Cooper A, Brown J, Boyd L, Levinson M. The prevalence of 26. Meddings J, Rogers MAM, Krein SL, Fakih MG, Olmsted RN, Saint S. peripheral intravenous cannulae and pattern of use: a point prevalence in a Reducing unnecessary urinary catheter use and other strategies to prevent private hospital setting. J Clin Nurs. 2018;27:e363–7. catheter-associated urinary tract infection: an integrative review. BMJ Qual 7. Ritchie S, Jowitt D, Roberts S, Auckland District Health Board Infection Saf. 2014;23:277–289. Control Service. The Auckland City Hospital Device Point Prevalence Survey 2005: utilisation and infectious complications of intravascular and urinary devices. N Z Med J. 2007;120:U2683. 8. Alexandrou E, Ray-Barruel G, Carr PJ, Frost S, Inwood S, Higgins N, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015;10:530–3. 9. American Society of Anesthesiologists. ASA Physical Status Classification System - American Society of Anesthesiologists (ASA) [Internet]. [cited 2018 Jul 26]. Available from: https://www.asahq.org/standards-and-guidelines/asa- physical-status-classification-system 10. Gallant P, Schultz AA. Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 2006;29:338. 11. Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen, Robert Koch-Institut. Definitionen nosokomialer Infektionen für die Surveillance im Krankenhaus-Infektions-Surveillance-System (KISS- Definitionen) [Internet]. 2017 [cited 2018 Oct 15]. Available from: https:// www.nrz-hygiene.de/en/surveillance/hospital-infection-surveillance-system/ kiss-definitionen/ 12. Kommission, für Krankenhaushygiene und, Infektionsprävention (KRINKO) beim Robert, Koch-Institut. Prävention von Infektionen, die von Gefäßkathetern ausgehen. Teil 2 – Periphervenöse Verweilkanülen und arterielle Katheter Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2017;60:207–215. 13. Reilly J, Stewart S, Allardice G, Noone A, Robertson C, Walker A, et al. NHS Scotland national HAI prevalence survey. Final report 2007, Health protection Scotland. 2007. 14. Zhang L, CaoS,Marsh N, Ray-Barruel G, FlynnJ,Larsen E,etal. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016;17:207–13. 15. Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín- Rabadán P, et al. Nationwide study on peripheral-venous-catheter- associated-bloodstream infections in internal medicine departments. J Hosp Infect. 2017;97:260–6. 16. Ezingeard E, Coudrot M, Guyomarc’h S, Aubert G, Blanc JL, Bertrand JC, et al. Evaluation of colonisation of peripheral venous catheters inserted by prehospital emergency service teams (SMUR) in France. J Hosp Infect. 2009; 72:169–75. 17. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81:1159–71. 18. Thomas A, Hayes P, Lockie T, Harrington D. Venflons: why can’t we resist putting them in? J Hosp Infect. 2006;63:108–9. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Antimicrobial Resistance & Infection Control Springer Journals

Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany

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Copyright © 2019 by The Author(s).
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Biomedicine; Medical Microbiology; Drug Resistance; Infectious Diseases
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10.1186/s13756-019-0468-8
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Abstract

Background: Bloodstream infections (BSI) are among the most frequently documented healthcare-associated infections (HAI). Central and peripheral venous catheters (CVC and PVC) are relevant risk factors for BSI. Although the risk for BSI is higher for CVC, PVC are utilized more frequently and are therefore relevant in the context of HAI prevention. Robust data on the prevalence of PVC and associated infections in German hospitals are scarce to this date. The objectives of this survey were to estimate the prevalence of PVC and PVC-associated infections on peripheral wards of a large tertiary care hospital in Germany. The collected data may be utilized for a tailored infection prevention intervention in the future. Methods: A point prevalence survey was conducted on peripheral wards of a tertiary care hospital with more than 3.000 beds. Data were collected between August 2017 and February 2018. Standardized data collection forms were used for collecting ward, patient and PVC-related data. As endpoints, prevalence of patients with PVC, PVC- associated infections and PVC without usage in the 24 h prior to the survey and without documentation of intended usage in the 24 h after the survey (“unused PVC”) were chosen. For data analysis, Kruskal-Wallis test was employed for continuous variables and Chi-squared test or Fisher’s exact test for categorical variables. Multivariable analysis and logistic regression were performed for the endpoint unused PVC. Results: Data from 2.092 patients on 110 wards were collected. The overall prevalence of patients with PVC was 33%. Infections were recorded in 16 patients. Except one case of BSI, these were all local infections at the site of insertion. Of 725 documented PVC, 77 (11%) were unused PVC. Multivariate analysis and logistic regression revealed wards with the practice of regularly obtaining blood from PVC, PVC with dirty or loose insertion dressing, pediatric ward specialty and last inspection of the PVC more than 1 day ago as significant risk factors for unused PVC. Conclusions: A substantial proportion of patients presented with a PVC on the day of survey. Too few infections were recorded to allow for more detailed analyses. Various risk factors for unused PVC were identified. We hereby present a solid method to obtain an overview about PVC use and to increase awareness for PVC-associated risks. The limitations of point prevalence surveys have to be recognized. Keywords: Infection control, Bloodstream infection, Sepsis, Phlebitis, Peripheral venous catheter, Healthcare- associated infection, Point prevalence survey * Correspondence: seven-johannes-sam.aghdassi@charite.de Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 2 of 7 Background were collected for all patients, which presented with a Healthcare-associated infections (HAI) are a challenge in PVC on the day of survey as well as for patients with an the practice of modern medicine. The prevalence of HAI active PVC-associated infection, even if the PVC had in patients hospitalized in German acute care hospitals has already been removed on the day of survey. An active in- been estimated to be approximately 4.6% [1]. A relevant fection was defined either as fulfilling case definitions on portion of these infections are device-associated [2, 3]. For the day of survey or as having fulfilled case definitions bloodstream infections (BSI) the most important risk fac- prior to the survey and still receiving treatment for the tor is the use of central venous catheters (CVC) and infection, even if symptoms of the infection were no lon- peripheral venous catheters (PVC). The risk for BSI per ger present. On the PVC level, the date of insertion, the PVC is lower than per CVC, whereas the application rate insertion site, the size of the PVC by Birmingham gauge of PVC is substantially higher [4, 5], as PVC represent one (G), the kind and condition of the insertion dressing, the of the most frequently used medical devices in hospitals last usage of the PVC before the survey and the intended [6–8]. Estimations of prevalence rates for PVC range from next usage after the survey, whether a catheter extension 24 to 100% across different countries [8]. In Germany, set was used, which is recommended by the German there is a lack of robust published prevalence data con- Commission for Hospital Hygiene and Infection Preven- cerning PVC use in hospitals. Furthermore, only recently tion [12], and indicators concerning PVC documentation has the collection of data on PVC utilization been intro- were collected. For more details, please find the translated duced as a part of the German national surveillance net- questionnaires in the Additional file 1. work (Krankenhaus-Infektions-Surveillance-System, KISS). The aims of this survey were to estimate the preva- Data collection lence of PVC and PVC-associated infectious complica- The prevalence survey was conducted on 110 peripheral tions, and to assess indicators of PVC management on wards of the Charité-University Medicine Hospital. Inten- all wards in a tertiary care university hospital, as a prep- sive care units, intermediate care units and outpatient set- aration for a tailored infection control intervention to tings were excluded from the survey. From August 2018 optimize PVC use and management. to February 2018 the data collection was executed by a single infection control nurse supervised by two infection Methods control physicians. The point prevalence survey was conducted on peripheral wards of all three campuses of the Charité-University Statistical analysis Medicine Hospital in Berlin, Germany, a tertiary care Univariable and multivariable analysis were used to com- university hospital with more than 3.000 beds and about pare two groups. Data was subjected to univariable ana- 150.000 inpatient cases per year. lysis using Kruskal–Wallis-test for continuous data and Chi-squared test for categorical data. When necessary, Questionnaire Fisher’s exact test was used instead of Chi-squared test. In Standardized data collection forms were designed to addition, data were analyzed by logistic regression for the collect ward, patient and PVC data. On the ward level, outcome whether PVC were still in use (i.e. usage within the handling of PVC was assessed through a standard- the 24 h prior to the survey and/or documented intended ized questionnaire to be answered by the head of nurs- use in the 24 h after the survey). The following covariates ing of the respective ward. Among the data collected were included: at the ward level: ward specialty, number were questions exploring which professional groups of beds, percentage of occupied beds, prevalence of were generally responsible for PVC insertion, whether patients with PVC on the ward, regular blood sampling PVC were used to draw blood, and whether a catheter via catheter, regular use of a catheter extension set; at the extension set was regularly used. The use of such catheter patient level: age, sex, time span between admission to the extension sets has been promoted by the local hospital hospital and survey, time span between admission to the infection control team in recent years. On the patient ward and survey, ASA score; on the PVC level: size of level, age, sex, the Physical Status Classification of the PVC, use of a catheter extension set, anatomic location of American Society of Anesthesiologists (ASA) score [9], the PVC insertion site, condition of dressing, and time thenumberofinsertedPVC at thetimeofsurveyand span between last inspection and survey. Covariates PVC-associated infections were recorded. Phlebitis was were selected by forward backward selection and in- evaluated according to the Visual Infusion Phlebitis Score cluded in the model if p = 0.05 and excluded from the [10], other PVC-associated infections were defined ac- model if p >0.10. A p-value of less than 0.05 was con- cording to the definitions used in the German KISS [11], sidered significant. Only 696 datasets were included in which are based on the definitions of the United States the logistic regression, 29 datasets were excluded be- National Healthcare Safety Network. Patient-related data cause of missing values. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 3 of 7 All analyses were performed using R 3.4.3 (R Foundation Table 1 Patient and peripheral venous catheter-related data for Statistical Computing, Vienna, Austria) and SAS 9.4 Parameter Number (percentage) (SAS Institute Inc., Cary, NC, USA). Patients, total 687 Ethical approval Sex male 360 (52) All data were anonymized and collected in accordance Age in years 57 to paragraph 23 of the German federal law, German Pro- ASA score 2.7 tection against Infection Act (“Infektionsschutzgesetz”), Days of hospitalization until survey 4 which regulates the prevention and control of infectious Patients with ≥ 1 PVC 681 diseases in humans. Therefore, ethical approval and in- PVC, total 725 formed consent were not required. Patients with PVC-related infection(s) 16 Results PVC with catheter extension set 309 (43) Data from 2.092 patients in 110 wards were collected Site of insertion between August 2017 and February 2018. 681 of these back of hand 267 (37) patients had one or more PVC on the day of survey. The forearm 245 (34) overall PVC prevalence was found to be 33% with sub- upper arm incl. elbow 204 (28) stantial differences between wards. Figure 1 illustrates the differences in PVC prevalence between wards. Insertion of other 9 (1) PVC was reported by all wards to be done primarily by Size of PVC by Birmingham gauge (G) medical doctors or students of medicine. In 58 wards G24/G22 136 (19) (53%) PVC were regularly or occasionally used to obtain G20/G18 558 (77) blood samples from patients. A catheter extension set was G16/G14 31 (4) reported to be regularly used in 51 (46%) wards. Transparent insertion dressing 725 (100) Patient-related data were collected for a total of 687 patients. The data are summarized in Table 1. Infections Dressing loose or dirty 87 (12) were recorded in 16 patients. Ten (63%) of these pa- Days from insertion until survey 2 tients had a PVC on the day of survey. In four patients, Last usage before survey in hours 7.2 the infection was associated with a PVC that was still No documented usage in 24 h prior and 77 (11) present on the day of survey. In all other cases, the PVC after survey related to the infection had already been removed (n =6) Catheter insertion documented in 629 (87) or had been removed and a new PVC was placed at a patient charts different site (n = 6). The presence of only local signs of PVC inspected by ward staff on the day 441 (61) of survey or day before ASA Physical Status Classification of the American Society of Anesthesiologists, a b PVC peripheral venous catheter(s); mean; median infections at the site of insertion were reported in 15 pa- tients. Four of these patients received conservative local treatment (incl. Cooling and immobilization). In one patient, a PVC-related thrombophlebitis as well as a PVC-related BSI (fulfilling the KISS-definitions for primary sepsis) were recorded. Staphylococcus aureus was identified as the causing pathogen. The patient received antimicrobial treatment. Data on a total of 725 PVC in 681 patients were collected (Table 1). Nine (1%) of 725 PVC showed signs of infection such as pain, induration, redness, and swelling. No visual phlebitis score higher than two was recorded in the survey. Univariable analysis focusing on risk factors for PVC without usage in the 24 h prior and after the survey Fig. 1 Prevalence of patients with peripheral venous catheters per (referred to as “unused PVC”) revealed pediatric ward ward. Scatter plot of prevalence of patients with peripheral venous specialty, the practice of regularly using PVC for blood catheters (PVC) per ward sampling, small size of the PVC, bad condition of the Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 4 of 7 insertion site dressing as well as a long interval since Logistic regression as illustrated in Table 3 revealed that last inspection as significant risk factors of unused patients in pediatric wards had a significantly higher risk of PVC. The use of a catheter extension set was identified having an unused PVC than patients in medical wards. Dif- as decreasing the likelihoodofunusedPVC (Table 2). ferences were also found when comparing medical wards Table 2 Univariable analysis of risk factors for peripheral venous catheters without usage in the 24 h prior and after survey PVC with usage (n = 627) PVC without usage (n = 69) p-value number (percentage) number (percentage) PVC regularly used for blood sampling on ward 373 (59) 59 (86) < 0.05 Regular use of catheter extension set on ward 331 (53) 19 (28) < 0.05 Ward specialty < 0.05 Medical 307 (49) 20 (29) Surgery 119 (19) 16 (23) Other surgery 134 (21) 17 (25) Interdisciplinary/other 38 (6) 8 (12) Pediatrics 29 (5) 8 (12) Number of beds on ward > 22 (median) 303 (48) 28 (41) 0.27 Percentage of occupied beds per ward (mean) 88.6 88.6 0.94 Prevalence of patients with PVC on ward (mean) 43.5 44.2 0.58 Sex, male 331 (53) 33 (48) 0.51 Age (in years) 0.86 0–18 32 (5) 4 (6) 19–35 90 (14) 12 (17) 36–55 119 (19) 10 (14) 56-70 178 (28) 19 (28) > 70 208 (33) 24 (35) Hospital stay > 7 days 168 (27) 14 (20) 0.30 Stay on ward > 7 days 121 (19) 10 (14) 0.41 ASA score 0.09 1–2 130 (21) 21 (30) 3–5 497 (79) 48 (70) Insertion site 0.34 Back of hand 225 (36) 30 (43) Forearm 211 (34) 25 (36) Upper arm incl. elbow 186 (30) 14 (20) Other 5 (1) 0 (0) Size of PVC by Birmingham gauge (G) < 0.05 G24/G22 126 (20) 5 (7) G20/G18 477 (76) 59 (86) G16/G14 24 (4) 5 (7) Dressing loose or dirty 65 (10) 20 (29) < 0.05 Days since last inspection < 0.05 0 213 (34) 2 (3) 1 394 (63) 46 (67) > 1 20 (3) 21 (30) PVC with catheter extension set 292 (47) 19 (28) < 0.05 a b c PVC peripheral venous catheter(s); incl. internal medicine, dermatology, neurology, geriatrics; traumatology and abdominal surgery; incl. urology, gynecology, otolaryngology Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 5 of 7 Table 3 Logistic regression model of risk factors for peripheral common invasive procedures in hospitals [6, 15, 16]. The venous catheters without usage in the 24 h prior and after survey BSI infection rate per 1.000 PVC device-days is estimated Odds Ratio p-value to be around 0.6 (95CI 0.2–0.9) [17]. Therefore, due to the (95%-confidence interval) frequency of application and severity of possible complica- PVC regularly used for blood sampling on ward < 0.05 tions the topic gains very high relevance from a public No reference health perspective. A substantial proportion of PVC were identified as un- Yes 3.37 (1.60–7.10) used PVC on the day of survey. On wards, where the Days since last inspection < 0.05 healthcare personnel regularly obtained blood from PVC, 2–8 reference a significantly higher number of unused PVC were re- 0 0.01 (0.00–0.04) corded. These unused PVC were less likely to be inspected 1 0.13 (0.06–0.28) on the day of survey or the day before and therefore can Ward specialty < 0.05 be regarded as an unnecessary infection risk for the pa- tient in two respects: first, the mere presence of an inva- Medical reference b sive device that might no longer be needed; second, the Surgery 1.26 (0.57–2.74) lack of inspection of the device. Our method of data Other surgery 1.32 (0.62–2.84) collection did not allow for differentiating whether an Interdisciplinary/other 2.08 (0.77–5.64) inspection, that was carried out, was simply not docu- Pediatrics 10.41 (2.71–40.07) mented or whether no inspection was undertaken in the Condition of insertion dressing < 0.05 first place. Both possibilities, however, illustrate the need for improving systematic PVC management and Dirty or loose reference documentation. The fact that multivariable analysis Well-maintained 0.25 (0.13–.0.48) revealed a loose or dirty (i.e. not well-maintained) in- PVC peripheral venous catheter(s); incl. internal medicine, dermatology, b c sertion dressing to be a risk factor for unused PVC, neurology, geriatrics; traumatology and abdominal surgery; incl. urology, gynecology, otolaryngology corroborates this result. It remains unclear whether the high number of unused to wards of other specialties, however, these were not sig- PVC (as defined by the above-stated criteria) were sim- nificant. Furthermore, logistic regression identified patients ply forgotten by the ward staff or intentionally remained on wards, where PVC were regularly used for obtaining inserted to be available in case the patient’s condition blood samples to have a significantly higher risk of having changed, and an intravenous application of fluids or an unused PVC, than patients on wards where PVC are medication became necessary again. The practice of rarely or never used for drawing blood. A dirty or loose leaving PVC inserted “just in case” is a phenomenon that insertion dressing was revealed to be a significant risk factor was previously described by other authors [18–20]. for unused PVC by multivariable analysis. Inspection on These studies and our data emphasize the importance the day of survey or within the 24 h prior significantly of a daily, systematic, and documented inspection of reduced the risk for unused PVC when compared with PVC which should be an integral part of good clinical inspection more than 2 days before the survey. practice [12, 21]. Education and feedback of PVC-related surveillance Discussion data or topics have frequently been cited as effective We analyzed data of over 2.000 patients. Approximately intervention strategies to improve PVC use and manage- one in three patients (681) presented with one or more ment [21–23]. However, the basis of education and feed- PVC on the day of the point prevalence survey. A simi- back are information such as the data collected in the lar prevalence was reported in a study in the United present survey. This kind of data collection is intensive Kingdom by Reilly et al. [13]. In our survey too few in- in time and personnel expenditure. Other intervention fections were recorded to allow for detailed analyses of strategies such as checklists or daily reminder systems risk factors. In total, PVC-related infectious complica- may be effective as well, and easier to establish [24–26]. tions were found in very few of the recorded PVC. Interestingly, multivariate analysis revealed that the Except one case of PVC-related BSI, these were all local practice of regularly using catheter extension sets signifi- infections, ranging from redness and swelling to signs of cantly decreased the probability of unused PVC. This thrombophlebitis. These findings indicate that PVC at our can be seen as an indicator that wards which have a high hospital, from the perspective of an individual patient, educational level with regard to PVC management are pose a low risk for catheter-related BSI or other severe in- more likely to realize timely catheter removal, thus, fectious complications. Other studies have yielded similar demonstrating the efficacy of the above-mentioned inter- results [14]. The insertion of PVC is one of the most vention strategies. Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 6 of 7 Patients in pediatric wards were identified by multivari- factors. Some of these factors appear to be structural or able analysis to have a significantly higher risk for unused organizational, such as the practice of regularly using PVC than patients in medical wards. This is especially PVC for obtaining blood samples. It appears that PVC critical since these patients represent a particularly vulner- may remain inserted longer because of convenience rea- able population. Univariate analysis showed that smaller sons, thereby putting patients at an unnecessary risk for PVC (G24/G22) were a risk factor for unused PVC as well. PVC-related complications. Lower frequency of PVC Since smaller PVC are inserted more frequently in inspection seems to contribute to this negative effect. pediatric wards, this finding can be interpreted as a conse- Feasible intervention strategies generated from the data quence of the effect of the ward specialty. presented here, may be to feed back the data to clini- Point prevalence surveys provide a solid method to cians and relevant stakeholders, to organize targeted obtain an overview and to identify areas of potential im- education and training programs and to develop check- provement. Importantly, it has to be recognized that this lists and reminder systems to decrease the number of method entails relevant limitations. Among these are: unnecessary PVC and device-days. Only PVC present at the time of survey were Additional file recorded. PVC which may have been present in the Additional file 1: PVC_survey_questionaires_english_version. (DOCX 14 days before conducting the survey and which had kb) been removed before data collection were not recorded. Therefore, we cannot make an accurate Abbreviations statement on the frequency of PVC usage. ASA: American Society of Anesthesiologists; BSI: Bloodstream infection(s); Only PVC-associated infections which were active at CVC: Central venous catheter(s); G: Birmingham gauge; HAI: Healthcare- associated infection(s); KISS: Krankenhaus-Infektions-Surveillance-System; the time of survey were recorded. Infections occur- PVC: Peripheral venous catheter(s) ring before or after the survey could not be recorded with the methodology applied. Furthermore, patients Acknowledgements Not applicable. with severe infectious complications, such as BSI, may have been transferred to intensive care units. Funding Since data collection was conducted on peripheral The study was not funded. wards only, such infections would have been missed. Availability of data and materials Therefore, accurate estimations on the burden of The datasets used and analyzed in the context of this survey are available PVC-associated infections are not possible with the from the corresponding author upon reasonable request. data collected in the survey present. Authors’ contributions Ward data was collected through a systematic SA, FS, and PG organized the initial study design and development. DG, SA questionnaire to be answered by the head nurse. and FS led the data collection. CS conducted the statistical analysis with input from SA and FS, who also drafted the manuscript. PG has made These answers may be subjective in some cases. essential contributions to the interpretation of the data and to the Reluctance by ward staff to collect microbiological preparation of the manuscript. All authors approved the final version of the specimen in case of suspected infection may lead to manuscript. an underestimation of PVC-related infections. Ethics approval and consent to participate The present survey is a single-center survey and Not applicable, because all data were surveillance-based data which were cannot be used for extrapolations on a national level. obtained in accordance with the German Protection against Infection Act (“Infektionsschutzgesetz”). Patients with longer hospital stays are generally overrepresented in point prevalence surveys. Consent for publication Not applicable, because all data were surveillance-based data which were obtained in accordance with the German Protection against Infection Act A strength of the survey is that it represents a true (“Infektionsschutzgesetz”). cross-section of the included peripheral wards of our hospital since all patients of these wards were assessed. Competing interests All data were collected by a single infection control The authors declare that they have no competing interests. nurse, experienced and well-trained in aspects of surveil- lance and data collection. We thereby were able to re- Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in duce inter-rater bias to a minimum. published maps and institutional affiliations. Conclusion Author details Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Our survey demonstrated that the duration of insertion Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of PVC is not only determined by how long they are 2 of Hygiene and Environmental Medicine, Berlin, Germany. National utilized for intravenous application, but also by other Reference Center for the Surveillance of Nosocomial Infections, Berlin, Aghdassi et al. Antimicrobial Resistance and Infection Control (2019) 8:15 Page 7 of 7 Germany. Institute for Infection Prevention and Hospital Epidemiology, 19. Barlow GD, Palniappan S, Mukherjee R, Jones MC, Nathwani D. Unnecessary Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, peripheral intravenous catheterisation on an acute medical admissions unit: Germany. a preliminary study. Eur J Intern Med. 2002;13:380–4. 20. Goddard L, Clayton S, Peto TEA, Bowler ICJW. The ‘just-in-case venflon’: Received: 17 October 2018 Accepted: 9 January 2019 effect of surveillance and feedback on prevalence of peripherally inserted intravascular devices. J Hosp Infect. 2006;64:401–2. 21. Boyd S, Aggarwal I, Davey P, Logan M, Nathwani D. Peripheral intravenous catheters: the road to quality improvement and safer patient care. J Hosp References Infect. 2011;77:37–41. 1. Behnke M, Aghdassi SJ, Hansen S, Diaz LAP, Gastmeier P, Piening B. The 22. Fakih MG, Jones K, Rey JE, Takla R, Szpunar S, Brown K, et al. Peripheral prevalence of nosocomial infection and antibiotic use in German hospitals. venous catheter care in the emergency department: education and Dtsch Arztebl Int. 2017;114:851–7. feedback lead to marked improvements. Am J Infect Control. 2013;41:531–6. 2. Vincent J-L, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin M-H, 23. Frigerio S, Giulio PD, Gregori D, Gavetti D, Ballali S, Bagnato S, et al. et al. The prevalence of nosocomial infection in intensive care units in Managing peripheral venous catheters: an investigation on the efficacy of a Europe: results of the European prevalence of infection in intensive care strategy for the implementation of evidence-based guidelines. J Eval Clin (EPIC) study. JAMA. 1995;274:639–44. Pract. 2012;18:414–9. 3. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for 24. Fasugba O, Cheng AC, Russo PL, Northcote M, Rosebrock H, Mitchell BG. nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40. Reducing urinary catheter use: a protocol for a mixed methods evaluation 4. Rickard CM, Webster J, Wallis MC, Marsh N, McGrail MR, French V, et al. Routine of an electronic reminder system in hospitalised patients in Australia. BMJ versus clinically indicated replacement of peripheral intravenous catheters: a Open. 2018;8:e020469. randomised controlled equivalence trial. Lancet. 2012;380:1066–74. 25. Youngerman BE, Salmasian H, Carter EJ, Loftus ML, Perotte R, Ross BG, et al. 5. Ahlqvist M, Berglund B, Nordstrom G, Klang B, Wirén M, Johansson E. A new Reducing indwelling urinary catheter use through staged introduction of reliable tool (PVC assess) for assessment of peripheral venous catheters. J electronic clinical decision support in a multicenter hospital system. Infect Eval Clin Pract. 2010;16:1108–15. Control Hosp Epidemiol. 2018;39:902–8. 6. Wong K, Cooper A, Brown J, Boyd L, Levinson M. The prevalence of 26. Meddings J, Rogers MAM, Krein SL, Fakih MG, Olmsted RN, Saint S. peripheral intravenous cannulae and pattern of use: a point prevalence in a Reducing unnecessary urinary catheter use and other strategies to prevent private hospital setting. J Clin Nurs. 2018;27:e363–7. catheter-associated urinary tract infection: an integrative review. BMJ Qual 7. Ritchie S, Jowitt D, Roberts S, Auckland District Health Board Infection Saf. 2014;23:277–289. Control Service. The Auckland City Hospital Device Point Prevalence Survey 2005: utilisation and infectious complications of intravascular and urinary devices. N Z Med J. 2007;120:U2683. 8. Alexandrou E, Ray-Barruel G, Carr PJ, Frost S, Inwood S, Higgins N, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015;10:530–3. 9. American Society of Anesthesiologists. ASA Physical Status Classification System - American Society of Anesthesiologists (ASA) [Internet]. [cited 2018 Jul 26]. Available from: https://www.asahq.org/standards-and-guidelines/asa- physical-status-classification-system 10. Gallant P, Schultz AA. Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 2006;29:338. 11. Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen, Robert Koch-Institut. Definitionen nosokomialer Infektionen für die Surveillance im Krankenhaus-Infektions-Surveillance-System (KISS- Definitionen) [Internet]. 2017 [cited 2018 Oct 15]. Available from: https:// www.nrz-hygiene.de/en/surveillance/hospital-infection-surveillance-system/ kiss-definitionen/ 12. Kommission, für Krankenhaushygiene und, Infektionsprävention (KRINKO) beim Robert, Koch-Institut. Prävention von Infektionen, die von Gefäßkathetern ausgehen. Teil 2 – Periphervenöse Verweilkanülen und arterielle Katheter Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsbl 2017;60:207–215. 13. Reilly J, Stewart S, Allardice G, Noone A, Robertson C, Walker A, et al. NHS Scotland national HAI prevalence survey. Final report 2007, Health protection Scotland. 2007. 14. Zhang L, CaoS,Marsh N, Ray-Barruel G, FlynnJ,Larsen E,etal. Infection risks associated with peripheral vascular catheters. J Infect Prev. 2016;17:207–13. 15. Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín- Rabadán P, et al. Nationwide study on peripheral-venous-catheter- associated-bloodstream infections in internal medicine departments. J Hosp Infect. 2017;97:260–6. 16. Ezingeard E, Coudrot M, Guyomarc’h S, Aubert G, Blanc JL, Bertrand JC, et al. Evaluation of colonisation of peripheral venous catheters inserted by prehospital emergency service teams (SMUR) in France. J Hosp Infect. 2009; 72:169–75. 17. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81:1159–71. 18. Thomas A, Hayes P, Lockie T, Harrington D. Venflons: why can’t we resist putting them in? J Hosp Infect. 2006;63:108–9.

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