Implementation of Isopropyl Caps to Increase Intravenous Catheter Disinfection by Anesthesia Providers

Abstract

Problem: Blood stream infections are a significant cause of morbidity and mortality in post procedural patients. Intravenous catheters can become portals of entry for microbials without proper disinfection. A single infection can cost institutions up to 75000 dollars. In an endoscopy unit at an inner city academic medical center less than 10% of anesthesia providers reported disinfection of intravenous catheters between medication injections. The biggest barrier to disinfection was lack of time due to the dynamic working environment. Purpose: The purpose of this quality improvement project was to implement isopropyl caps by anesthesia providers in an endoscopy unit at an academic medical center and change intravenous tubing assembly practices by endoscopy nursing staff with utilization of closed lumen claves on open lumen stopcocks. Methods: This project was implemented over a 15-week period following education to endoscopy nurses (N=9), providers (N=14), and anesthesia technicians (N=2). Three endoscopy nursing champions were appointed to facilitate intravenous tubing assembly practices and encourage providers to utilize caps. Visual reminders were placed in the preprocedural areas and operating suites to remind providers and nurses about process changes. To track adherence a quality response code linked to a survey was laminated at each anesthesia workspace for providers to scan and complete each shift. Results: Following implementation strategies, at the end of week one 50% of providers were utilizing caps between medication injections and 37.5% of intravenous tubing sets were reported to have closed lumen claves. The median compliance by week 15 was 54% and 56% respectively. Conclusions: Implementation of caps decreases intravenous catheter disinfection time making it more feasible for anesthesia providers to utilize. Unit champions and visual reminders helped to change intravenous tubing assembly practices allowing caps to fit onto injection ports. Agreement of champions to continue the practice and interest of underclassmen students in project can help to achieve sustainability and further dissemination of this intervention.