Peripheral intravenous cannulas (PIVCs) are utilized in large scale in modern health care. Known complications due to a PIVC are phlebitis, thrombosis, bleeding, nerve damage and infection. PIVC-related infection causes morbidity, mortality and increased healthcare costs. PIVC-related infections can and should be prevented. Indwell time is a known risk factor for PIVC-related infection. Another factor potentially influencing the risk of developing PIVC-related infection is what type of PIVC that is being used. Roughly there are two types of PIVCs. One with an open injection valve and another with a closed injection valve. The former being far more used in our hospital and the latter being suggested as lowering the risk of PIVC-related infection compared to the open one. The investigators aim with this study is to evaluate the incidence of PIVC-colonization in 300 patients at our 500-bed secondary level hospital in Sweden, as a first step in trying to understand what healthcare-providers can improve regarding prevention of PIVC-related infections.

Population

Setting The hospital is a 500-bed general county hospital including most medical, oncological and surgical specialties except neurosurgery and cardiac surgery. No solid organ or stem cell transplantations are performed. Patients Patients admitted to surgical, medical or infectious wards were regularly included by a specifically trained nurse from June 2016 until December 2017.

Brief Title

Peripheral Venous Catheter Colonization Study

Official Title

Incidence of Peripheral Intravenous Cannula Colonization in a Swedish County Hospital

Brief Summary

Peripheral intravenous cannulas (PIVCs) are utilized in large scale in modern health care.<br /> Known complications due to a PIVC are phlebitis, thrombosis, bleeding, nerve damage and<br /> infection. PIVC-related infection causes morbidity, mortality and increased healthcare costs.<br /> PIVC-related infections can and should be prevented.<br /><br /> Indwell time is a known risk factor for PIVC-related infection. Another factor potentially<br /> influencing the risk of developing PIVC-related infection is what type of PIVC that is being<br /> used. Roughly there are two types of PIVCs. One with an open injection valve and another with<br /> a closed injection valve. The former being far more used in our hospital and the latter being<br /> suggested as lowering the risk of PIVC-related infection compared to the open one.<br /><br /> The investigators aim with this study is to evaluate the incidence of PIVC-colonization in<br /> 300 patients at our 500-bed secondary level hospital in Sweden, as a first step in trying to<br /> understand what healthcare-providers can improve regarding prevention of PIVC-related<br /> infections.

Detailed Description

Background:

Peripheral intravenous cannulas (PIVCs) are utilized in large scale in modern health care.
Known complications due to a PIVC are phlebitis, thrombosis, bleeding, nerve damage and
infection. PIVC-related infection causes morbidity, mortality and increased healthcare costs.
In an Australian study the investigators found the presence of a PIVC the most frequent cause
(36%) of healthcare-associated Staphylococcus aureus bacteraemia during 2012. PIVC-related
infections can and should be prevented.

Indwell time is a known risk factor for PIVC-related infection. Another factor potentially
influencing the risk of developing PIVC-related infection is what type of PIVC that is being
used. Roughly there are two types of PIVCs. One with an open injection valve and another with
a closed injection valve. The former being far more used in Ryhov County Hospital, Sweden,
and the latter being suggested as lowering the risk of PIVC-related infection compared to the
open one.

In a systematic review from 2006 Maki et al report a point incidence of blood stream
infections of 0,5 per 1000 catheter-days in PIVCs. In 2014 Hammarskjöld reported an incidence
of 0,6 per 1000 catheter-days regarding central venous catheters (CVC). Maki et al concludes
"…, infection control programs must strive to consistently apply essential control measures
and preventive technologies with all types of intravascular devices." The investigators find
there is a gap between the large scale utilization of PIVCs and the knowledge about
PIVC-related infections and recommendations on how to prevent them. Hammarskjöld et al has
done research on infections related to CVCs, subcutaneous venous ports and on arterial
cannulas but not PIVCs.

The aim with this study is to evaluate the incidence of PIVC-colonization at Ryhov County
Hospital, a 500-bed secondary level hospital in Sweden, as a first step in trying to
understand what can be done to improve work regarding prevention of PIVC-related infections.

Materials and methods

Setting The hospital is a 500-bed general county hospital including most medical, oncological
and surgical specialties except neurosurgery and cardiac surgery. No solid organ or stem cell
transplantations are performed.

Patients Patients admitted to surgical, medical or infectious wards were regularly included
by a specifically trained nurse from June 2016 until December 2017.

Inclusion criteria: Patients ≥ 18 years of age with a PIVC in situ for 48 hours or more
informed verbally and in written and invited to take part in the study. Exclusion criteria:
Patients < 18 years of age.

Microbiological methods Intraluminal hub culturing from the two injection sites of the PIVC
performed with sterile cotton-tipped applicators moistened with sterile sodium chloride 0,9
%. Swabs transported in Amies medium with charcoal. Identification performed by standard
methods at our local microbiology laboratory (www.srga.org.accessed _ http://
www.srga.org.accessed/ _ January 1, 2007).

Statistics Descriptive. How many positive cultures and which type of microbes were found.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.