vascular access infection prevention
By Michelle DeVries MPH , CIC , VA-BC
Teaming Up for Improved Outcomes
The world of vascular access is supported by clinicians of many disciplines who insert , access and maintain devices from phlebotomy and short peripheral catheters through tunneled and fully implantable devices and also those who help study and understand outcomes including pharmacy , food and nutrition services , infection prevention / infectious disease , quality departments , risk management and case management among many others .” we collectively emerge from the incredible
As stressors of the past two years , it is time to rethink “ the way we ’ ve always done things .” While we may have acknowledged the truth of that statement in the past , it takes on even heavier significance in the context of what we collectively experienced . The world of vascular access is supported by clinicians of many disciplines who insert , access and maintain devices from phlebotomy and short peripheral catheters through tunneled and fully implantable devices and also those who help study and understand outcomes including pharmacy , food and nutrition services , infection prevention / infectious disease , quality departments , risk management and case management among many others . Organizations employ a variety of staff with different skills and knowledge with both generalist and specialist models prevalent today . Now is the time to re-evaluate and re-establish these relationships to collaborate for improving patient outcomes across all devices .
Within the infection prevention specialty , we , too , have a diverse group of practitioners working together to address the complex patient populations . Expanding representation beyond nursing allows for problem solving through different expertise . My ( all-CIC ) team at our large , urban , community hospital consists of two nurses ( one an MSN in nursing administration and one a DNP who is also a CNS ), a microbiologist and an MPH in hospital and molecular epidemiology . Together we can construct hypotheses and solutions , and then test , implement , and analyze to constantly drive our efforts toward continuous and innovative solutions . A wonderful enhancement to the field is the relatively recent addition of the associate-IPC ( a-IPC ) credential . For anyone interested in infection prevention and wanting to demonstrate a basic competency in the specialty , it is an accessible starting point . It may also be something for supportive departments ( i . e ., nursing professional development and vascular access / infusion therapy ) to consider , to help strengthen the collaborative potential between departments as we work together .
While infection prevention and vascular access may not always report to the same executive team leaders , we are a logical start for cross discipline group development . An initial focus may be a CLABSI prevention / quality improvement but the opportunities for collaboration extend far beyond that . In my own organization , these teams studied together , and half of each team achieved the Vascular Access Board Certification ( VA-BC ) together to help create a shared foundational knowledge on topics of mutual interest . It is a certification that is in the reach of everyone involved in the field , not limited only to nurses or inserters .
Beyond shared certifications , how do we develop and enhance the collaboration between our specialties ? Quality improvement projects and research studies allow a natural opportunity . Our co-authors and contributors have included the infection prevention team , bedside staff , vascular access specialists , clinical nurse specialists , nursing leadership , wound and ostomy nurses , nursing professional development as well as hospital epidemiologist . Internal projects have brought us together with emergency department and imaging services to tackle questions such as the overuse of the antecubital fossa for PIV access ; working with pharmacy and food and nutrition services as well as information technology to review opportunities for optimizing TPN utilization and minimizing associated risks as well as many others . External projects extend these collaborations to include remote instruction and competency assessment by vascular access experts outside of our organization , global surveys of clinical practices and implementation of standards and development of clinical practice guidelines and standards . Each of these benefit from a multitude of perspectives . Engaging local expertise in the development of policies and procedures can help ensure that all relevant literature and evidence-based guidance is included , rather than limited to those that a specific department is most familiar with . The same is true for the development of simulation exercises and competency assessment . Introducing feedback from each potential internal customer who could be impacted by the success or failure of a system can help engineer a broader consideration of safety into a process , which is the goal .
I am very fortunate to have the opportunity to straddle the fields of infection prevention and vascular access . As we look to strengthen the diversity of engagement to include all involved disciplines , we can define what that can look like . Within my institution , one way we strive for this is through our monthly vascular access jamboree . Led by infection prevention and including invitations to vascular access , nursing professional development / clinical nurse specialists , nursing leadership ( including emergency department ), quality management and others plus industry support from catheter , dressing , pump / tubing manufacturers as well as the variety of adjuncts we use ( CHG sponge dressing , alcohol -impregnated caps ,