Evidence based IV problem prevention

[RNCEN]

I'm posting this here in addition to the student section, for more exposure. Please move it if I should not put it here. I am doing an evidence based research project on IV therapy related infection/phlebitis prevention. There is plenty of evidence out there to support best practice, but the issue I am having is determining what the proposed change might be. Most nurses know that scrubbing the insertion site for 30 seconds, and scrubbing the hub for 15 seconds, avoiding the AC site, and clearly labeling dressings with the date and time is best practice....but how many do it?? What would be a reasonable way to entice nurses to do these types of things? Some type of contest involving a reward? Any ideas? I think that this truly is a costly issue, both in terms of $$ and human illness/suffering. There must be a way to invoke change in the daily habits of nurses involved directly with IV insertion and management. What are some ways (protocols/policies utilized) you are avoiding problems in your facilities?

Thanks in advance!

[BOOYARN]

I rarely sign and date the ivs. i clean, stick, check patency and cover it up and on to the next.

$$$$ would be a great reward..... I bet all ivs would be signed, dated, and resited. If that was the case.

But administrations is too greedy, and us nurses are under staffed, over worked.

Good luck with ur paper

[MunoRN, RN]

Evidence Based Practice doesn't get very far if the Evidence base for it is weak, or if those encouraging the practice do not have the respect of those they are encouraging.

The 15 second hub scrub is a good example of both of these. The need for a 15 second scrub hub was widely advocated in ANA publications, which only hurt it's chances of gaining acceptance since a large number of Nurses find the ANA to be a sub-par Nursing Practice organization (I have to agree). Another group pushing this practice change was the Infusion Nursing Society (INS), possibly the most unreliable source for practice information there is.

But even if you leave out that the ANA and the INS support this practice change when making a case for it, you're still left with the strength of the evidence. The single study that the 15 second rule is based on used 100 samples (relatively small for this type of study). The bacterial innoculum used in this study was exponentially weaker than that used in the study that showed a 3 second scrub to be insufficient as well as the majority of other studies that evaluate disinfection. All of the samples were scrubbed by the same practitioner in her office, ruling out variations in technique and environmental factors that may contribute to contamination. Worst of all, the study didn't include a 3 second scrub for comparison, it only looked at no scrubbing vs 15 seconds of scrubbing. And why 15 seconds? If 3 seconds isn't sufficient why not evaluate 6 seconds? 10 seconds?

In the end, I've found the success of advocating for an Evidence Based Practice change is directly related to the strength of the Evidence.