QUALITY IMPROVEMENT INITIATIVE: MAXIMIZING DRESSING ADHERENCE TO MINIMIZE INFECTIONS Lee Steere, RN, CRNI, VA-BC™ | Unit Leader, IV Therapy Services, Hartford Hospital
INTRODUCTION Like all hospitals, our organization is continually focused on optimizing the Institute for Healthcare Improvement’s Triple Aim in order to improve patient care, improve quality and reduce healthcare costs. One way to do this is by minimizing infections, particularly catheter-related bloodstream infections (CRBSIs), as these hospital-acquired infections result in longer hospital stays, increased mortality and significantly higher costs. While no single solution can prevent infections alone, numerous studies show that VAD dressing disruptions are a major risk factor for CRBSIs.1 Evidence-based guidelines from organizations like the U.S. Centers for Disease Control (CDC) and Infusion Nurses Society (INS) recognize the importance of vascular access device (VAD) dressing integrity in minimizing infection risks. The recent paradigm shift from routine to clinically indicated catheter replacement has further increased the importance of protecting insertion sites and making all VADs -- from central to peripheral intravenous (PIV) line -- remain in place longer. Unfortunately, data reveal that dressing disruptions happen far too frequently. We suspected this was the case at Hartford Hospital. Our IV Therapy Services team conducted a trial to test the impact of a gum mastic liquid adhesive on central venous catheter (CVC) dressing integrity. The marked improvement in dressing adherence led to a hospital-wide quality improvement initiative for all central lines to minimize infection risks, improve patient safety and reduce healthcare costs.
DRESSING INTEGRITY IS ESSENTIAL Proper dressing adherence is an essential part of catheter site care and maintenance. Intact dressings prevent complications like catheter migration, dislodgement and infiltration.
Most importantly, preserving dressing integrity can reduce the risk of CRBSIs. According to a 2012 study, the risk of infection increased more than 3-fold after the second dressing disruption, and increased 12fold if the final dressing was disrupted.1 Current guidelines from the INS and CDC define an “unplanned dressing change” as any change that happens within the first seven days -- yet research indicates that dressing disruptions happen with alarming frequency. In 2016, a study of four commercially available CVC dressings showed that the dressings had surprisingly limited durability, with the average dressing change happening every 50 hours -- far less than the recommended seven days. Only three percent of the dressings lasted the full seven days, and 75 percent lasted less than 48 hours.2 Through rounding, our IV therapy team observed that our dressing integrity was less than satisfactory, but we needed to conduct a point prevalence assessment to quantify this. Another hospital within our system, the Hospital of Central Connecticut, had experienced improved dressing adherence with the use of a gum mastic liquid adhesive. In 2019, we began to consider this product as a potential solution that could minimize the dressing disruptions that were putting our patients at risk.
EVIDENCE-BASED LIQUID ADHESIVE Widely used in operating rooms since 1965, the safety and efficacy of gum mastic liquid adhesive is well-documented. It is clinically proven to enhance the adhesive power of a variety of tapes and dressings, performing better than tincture of benzoin or no pretreatment at all.3,4 The non-water soluble, latex-free adhesive is shown to be well-tolerated with a low risk of adverse reactions.4 More recently, as researchers began to explore the use of gum mastic liquid adhesive in vascular access, they found that it provides effective securement and CONTINUED ON NEXT PAGE AUGUST / SEPTEMBER 2021 21
