Sustainable strategy reduces inappropriate intravenous apply by one third

The Amsterdam UMC study, conducted over five years and involving 1,100 patients, showed the strategy reduced inappropriate intravenous apply by one third, an effect that was maintained over the five-year period. It should also lead to a reduction in the number of related infections, which affect one in ten patients. The results were published today in Lancet eMedicineClinical.

Infections from both IV lines and catheters occur in more than 10% of patients, and studies suggest that up to a quarter are unnecessary. This simply means that patients are exposed to an unnecessarily high risk of infection. This can delay or even impede their recovery.”

Suzanne Geerlings, professor of internal medicine at Amsterdam UMC

To combat this, the research team published a strategy in the Lancet Infectious Diseases in 2017. The strategy led to a 37% reduction in the number of unnecessary or inappropriately used catheters.

“When we talk about inappropriate apply, we usually mean catheters that are in place too long or, in the case of urinary catheters, when the patient does not have sufficient support,” Geerlings adds.

The study included 1,113 patients. Of these, 962 had an intravenous catheter, typically used for fluid administration, while 151 had a urinary catheter, and the remaining 962 had an intravenous catheter.

“What’s really engaging is that no study has looked at how strong these recommendations are, and that’s true for many modern strategies in the healthcare sector. In this case, it’s clear that the effects have been sustained over the last five years,” Geerlings says.

What, now why

To understand why their strategy continued to work, the research team interviewed 18 healthcare workers across the Netherlands. The interviews revealed that the strategy had permanently changed workflows in four of the five hospitals studied.

“By talking to people ‘in the field’, we learned what works and, perhaps more importantly, what doesn’t,” says Tessa van Horrik, a researcher at Amsterdam UMC and the study’s first author.

“The main barriers to sustaining the strategy were a combination of other priorities, lack of time, staff or both, and it is understandable that in some cases there was simply no one to lead the implementation over five years. This shows us that the strategy can work as long as the resources are there,” van Horrik adds.

Although the study also found that these resources do not have to be enduring, it found that a transient investment, in time or leadership, was sufficient to reduce unnecessary or inappropriate cannula and catheter apply.