International Nurses Day 2020: Case study of the week

Reducing bloodstream infections in an intensive care unit, Republic of Cyprus

Contributor: Stelios Iordanou

It is widely accepted that healthcare-associated infections (HAIs) are a significant cause of adverse healthcare-related events in hospitalised patients. These infections create a severe threat to patients' health that affects outcome as well as mortality rates. When HAIs occur in intensive care unit (ICU) patients, then everything becomes more severe.

In major intensive care in the Republic of Cyprus, we attempted to implement evidence-based procedures recommended by the Centres for Disease Control and Prevention (CDC) to reduce the number of catheter-related blood-stream infections after the high number were discovered in a review in 2015.

Difficulties were found with the recommendation for the prompt removal of central vascular catheters (CVCs), mainly due to problems in establishing peripheral venous access. To fully comply with the CDCs recommendation, we searched the literature and found that ultrasound-guided peripheral venous cannulation can be extremely helpful when there are problems in establishing peripheral vascular access.

We adopted this method as a supplementary intervention to CDC evidence-based procedures, which meant we were able to fully comply with the recommendation of removing unnecessary intravascular catheters or avoiding unnecessary placement.

When we examined the effects of these changes, we found that CVC utilisation ratios, the median of CVC use and the number of catheter-related blood-stream infections significantly dropped the subsequent year. Surprisingly, the 74% reduction in catheter-related blood-stream infections was greater than seen in any of the published literature.

The combination of these prevention efforts led to the avoidance of catheter-related blood-stream infections, and we believe several lives and a great number of resources have been saved as a result.

Catheter-related blood-stream infections are now in line with the lowest in the published literature. These results are evidence of nurses’ ability to be the lead voice in promoting health and high-quality care, driving advanced interventions and saving lives.

1. Iordanou S, Middleton N, Papathanassoglou E, Raftopoulos V. Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infect Dis. 2017;17(1):607. doi:10.1186/s12879-017-2704-2
2. Keyes LE, Frazee BW, Snoey ER, Simon BC, Christy D. Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med. 1999;34(6):711-714. . Accessed August 4, 2016.
3. Doniger SJ, Ishimine P, Fox JC, Kanegaye JT. Randomized Controlled Trial of Ultrasound-Guided Peripheral Intravenous Catheter Placement Versus Traditional Techniques in Difficult-Access Pediatric Patients. Pediatr Emerg Care. 2009;25(3):154-159. doi:10.1097/PEC.0b013e31819a8946
4. Iordanou S, Middleton N, Papathanassoglou E, Palazis L, Raftopoulos V. Should the CDC’s recommendations for promptly removing unnecessary centrally inserted central catheters be enhanced? Ultrasound-guided peripheral venous cannulation to fully comply. J Vasc Access. July 2019:112972981986355. doi:10.1177/1129729819863556