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Reassessing standards of vascular access device care: a follow-up audit

25 April 2019
Volume 28 · Issue 8

Abstract

This article reports on the findings of a repeat audit of vascular access devices (VADs) in a district general hospital undertaken 4 years after a previous audit. The first demonstrated poor standards of care and low compliance with evidence-based guidelines, indicating that a change in practice was necessary. A strategy of training, education and standardisation for intravenous devices was introduced, with the goal of transforming practice to raise standards and improve compliance. The findings of the follow-up audit show that the strategy has been successful in raising standards of care and reducing infections.

Vascular access devices (VADs) (peripheral and central) are vital for the administration of medication and other prescribed intravascular (IV) therapy. Although these devices are essential, they put patients at risks of complications. These include, but are not limited to:

CR-BSIs are associated with the insertion and maintenance of VADs and are among the most dangerous complications for patients (Loveday et al, 2014). HCAIs are reported to affect approximately 300 000 patients each year; they were responsible for over 5500 deaths from Gram-negative infections (such as Escherichia coli) in 2015 and were set to cost the NHS more than £2 billion by 2018 (Mackley et al, 2018). Studies have reported that between 5.1% and 11.6% of hospitalised patients will acquire at least one HCAI (World Health Organization (WHO), 2010), with the greatest risks in intensive care units (ICUs), where the prevalence is 23.4% (Health Foundation, 2015), and the proportion of infected patients can be as high as 51% (WHO, 2010). It is reported that bloodstream infections (BSIs) represents about 12% of all HCAIs, and occurrences in Europe have been estimated at over 4.5 million annually, with approximately 37 000 deaths as a direct consequence and an extra 16 million days of hospital stay (Zingg, 2015; Public Health England, 2016). HCAIs have a significant impact on morbidity and mortality; however, they are largely preventable. Consequently, reducing them has become the focus of infection prevention and control interventions and strategies.

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