[Effect of a long-term quality improvement program on the risk of infection related to peripheral venous catheters]

Although peripheral venous catheter (PVC) placement is one of the most common invasive procedures used in hospitals, data about the infectious risk associated with it are sparse. Nurses and physicians often underestimate this risk. We describe here a 10-year continuous quality improvement program in a large university hospital.

The prevention program included: 1/ an observational audit of practices of PVC insertion and maintenance (1996), 2/ two studies of incidence and risk factors for PVC-related infection (1996 and 1999), 3/ 8 annual (1996 to 2006) cross-sectional studies that collected information about duration of PVC placement and other process indicators, 4/ surveillance of nosocomial bacteremia from 2002 through 2006, and 5/ continued education sessions for healthcare workers, based on local surveillance data.

Rates of colonization and infection (0.7 cases of bacteremia/1000 PVC days) were similar to data from other studies. PVC that remained in place for more than three days was associated with a higher risk of catheter-related bacteremia in both incidence studies. The annual prevalence studies showed that 15 to 20% of PVCs remained in place for more than three days from 1996 through 2002, but this rate decreased thereafter; it was 6.7% in 2005 and 10.7% in 2006. Practices audits indicated room for improvement in prevention measures. The absolute number of PVC-related bacteremia decreased by more than 50% from 2002 (n=23) to 2006 (n=10).

This prolonged multifaceted program, including practice audits, continued medical education and monitoring of PVC-related infection, has led to a substantial decrease over time in the infectious risk related to PVC placement.