I'm not really sure who the attacker/attackee is supposed to be but nothing intended and/or nothing taken.
My concern with the INS lie in two main areas. The first is not only that they seem to lack a basic familiarity with current practice, but that the manner in which they deal with these mistakes lacks the integrity that should be expected of any group the claims to be an "authority" in any type of Nursing practice. The second is that they appear unfamiliar, or even worse uninterested, in the responsible use of Evidence Based Practice.
Prior to a couple of years ago, I hadn't found the INS useful due to vague and out out of date info, but I didn't despise it either. Then my hospital made the ill-fated decision of basing it's IV policy on a direct interpretation of the INS standards. This was at first merely annoying, since the INS clearly didn't understand the difference between primary and secondary tubing among other things.
Then we had a near sentinel event that was directly due the INS's incorrect terminology. We had a nurse float to the tele unit (she normally worked in the outpatient unit which rarely used IV pumps) so when she needed to start a NTG gtt she referred to our IV policy. We run slow running gtts with a carrier fluid, and according to the INS definitions this meant that the NTG was the "secondary", so the nurse programmed the NTG into it's pump as a "secondary". When the VTI on the secondary program reached zero, the pump then reverted to the old primary rate from the last patient (100ml/hr). Luckily the error was caught early (due to the hints provided by the patient vomiting and then passing out).
If it was just an issue of incorrect terminology it would have been an easy fix in terms of our policy, but we were still left with trying to reconcile the CDC tubing change recommendation that both primary and secondary tubing changes should be changed no more often than every 72 hours with the INS recommendation that secondary "intermittent" tubing be changed every 24 hours. The CDC recommendation is category 1A and based on evidence that tubing changes more often than 72 hours not only has no benefit but actually appears to increase contamination risk. The INS's contradiction of the CDC's evidence based recommendation was not based on any evidence whatsoever, so we tried to at least understand their rationale, which was apparently that they were concerned that repeated manipulations at the catheter hub had an assumed risk due to the going under the dressing and the possible leakage of blood at the hub itself. This was again perplexing since it's been common practice for some time to not use the actual catheter hub for routine access, every IV should have an extension, and many IV's are now "hubless" so accessing at the hub isn't even an option. Beyond that, real secondary lines aren't connected at the hub but at a port above the pump, making this even more confusing. As far as we could tell, these false assumptions about current practice were from a source that had not been updated on these topics since 1977, that source was the INS's own previously published reference. Sourcing yourself isn't acceptable in an English 101 research paper, I'm really not sure why the INS thought they didn't need to follow the same basic standard and refer to an outside source.
Everybody makes mistakes, it's how a person or group deals with those mistakes that helps define their character. I made multiple attempts to address the issues of terminology, safety, and clarifying the basis of their recommendations and got no response to phone calls or e-mails. We then tried again as our hospitals practice council as a whole, again no response. We had two different members of our practice council that are also members of the INS attempt to clarify these issues with the INS, again no response. Any self-proclaimed "authority" that puts out recommendations and then refuses to address concerns or clarify doesn't have the responsibility and integrity required to play that role. I realize it takes up time, particularly with so many issues the need to be addressed, but it's part of the deal.
The INS's difficulty with Evidence based practice extends beyond just the secondary tubing change frequency. Responsible use of Evidence based practice requires basing major practice changes on some basic level of evidence or at least properly qualifying the recommendations based on the level of evidence, otherwise we develop a distrust of Evidence based practice, which is something it is already too prevalent. The most recent example is that of the 15 second scrub. The Maki et al study was designed to to determine if IV tubing with valved ports posed a greater risk for contamination than non-valved tubing sets, and found that indeed the valved sets pose a significantly greater risk of infection. While the study brings up the issue of whether or not a 3-5 second scrub is really sufficient, citing this study as the main basis for declaring a 3-5 second scrub to be insufficient is a bad use of supposed evidence when this is not what the study was designed to determine. What this should have prompted, was a study designed specifically to compare the efficacy of a 3-5 second scrub with long scrub durations. Instead, the INS made a major practice change based on the Kaler, Chinn study.
The Kaler study is an excellent example of bad research and the sort of thing that a true EBP "authority" should have no problem evaluating and qualifying appropriately. The Maki et al study was an RCT, which took place in a real clinical setting using multiple clinicians, and since it's purpose was to compare two different types of tubing, both types were included in the study, if the study only looked at the new valved tubing without using the old tubing as a control, it would have been essentially useless. The Kaler study, meant to compare a 3-5 second scrub with a 15 second scrub, only included the 15 second scrub and did not include a shorter scrub duration as a control. It was also conducted in a conference room and all the scrubbing was done by the same person (Kaler), effectively eliminating the known variables that existed in the Maki et al study such as cross contamination and variations in technique. It also only used a 10^2 inoculum, comparatively weak to other studies meant to evaluate the effectiveness of a disinfection technique.
If the INS felt that the limited evidence available was sufficient to justify hasty action, which I tend to agree with, the action should have been to advise that valved tubing sets not be used until it's safety has been better established, since the only thing we knew at that point was that valved tubing was more likely to be contaminated, and there was no reliable evidence that a longer scrub time made any difference. I realize this would have been a difficult position to take when a large portion of your funding comes from Braun, a supplier of valved tubing.
Since the Kaler study, there have been subsequent studies that include multiple scrub durations between 3 and 15 seconds and show no difference between them, suggesting that that the increase in contamination rates seen in valved tubing is not mitigated by a longer scrub duration. Spending an extra 10 seconds scrubbing a hub when it may not be necessary is not a horrible thing, but further contributing to a cynical view of any evidence and essentially crying wolf does have potentially serious consequences.
I'm not a member of the INS and while it's possible that someday I would value the work of the INS enough to contribute financially, currently they aren't exactly on my list of groups that I value enough to share my spare cash with.