Sustained Improvements in Peripheral Venous Catheter Care in Non–Intensive Care Units: A Quasi-Experimental Controlled Study of Education and Feedback

Abstract

Background and Objectives.Peripheral venous catheters (PVCs) can be associated with serious infectious complications. We evaluated the effect of education and feedback on process measures to improve PVC care and infectious complications.Design.Quasi-experimental controlled crossover study with sampling before and after education.Setting.An 804-bed tertiary care teaching hospital.Participants.Nurses and patients in 10 non-intensive care units.Methods.We implemented a process to improve PVC care in 10 non-intensive care units. The 4 periods (each 3 months in duration) included a preintervention period and a staggered educational intervention among nurses. During intervention period 1, 5 units participated in the intervention (group A), and 5 units served as a control group (group B). Group B underwent the intervention during intervention period 2, and both groups A and B received feedback on performance during intervention period 3. Process measures were evaluated twice monthly, and feedback was given to nurses directly and to the unit manager on a monthly basis.Results.During the preintervention period, there were no significant differences between groups A and B. Of 4,904 intravascular catheters evaluated, 4,434 (90.4%) were peripheral. By the end of the study, there were significant improvements in processes, compared with the preintervention period, including accurate documentation of dressing (from 442 cases [38%] to 718 cases [59%]; P<.0001), catheter dressing being intact (from 968 cases [88.5%] to 1,024 cases [95.2%]; P<.0001), and correct demonstration of scrubbing the hub before infusion (from 161 demonstrations [54%] to 316 demonstrations [95%]; P <.0001). There was a significant reduction in PVC-associated bloodstream infection, from 2.2 cases per 10,000 patient-days during the preintervention period (5 cases) to 0.44 cases per 10,000 patient days during the 3 intervention periods (3 cases; P = .016).Conclusions.Education and real-time feedback to nurses increases and sustains compliance with processes to reduce the risk of infection from PVCs.