title: Sustained improvements in peripheral venous catheter care in non-intensive care units: a quasi-experimental controlled study of education and feedback.
abstract: OBJECTIVE
  Peripheral venous catheters (PVCs) can be associated with serious infectious complications. We evaluated the effect of education and feedback on process measures to improve PVC care and infectious complications.
  
  
  METHODS
  Quasi-experimental controlled crossover study with sampling before and after education.
  
  
  METHODS
  An 804-bed tertiary care teaching hospital.
  
  
  METHODS
  Nurses and patients in 10 non-intensive care units.
  
  
  METHODS
  We implemented a process to improve PVC care in 10 non-intensive care units. The 4 periods (each 3 months in duration) included a preintervention period and a staggered educational intervention among nurses. During intervention period 1, 5 units participated in the intervention (group A), and 5 units served as a control group (group B). Group B underwent the intervention during intervention period 2, and both groups A and B received feedback on performance during intervention period 3. Process measures were evaluated twice monthly, and feedback was given to nurses directly and to the unit manager on a monthly basis.
  
  
  RESULTS
  During the preintervention period, there were no significant differences between groups A and B. Of 4,904 intravascular catheters evaluated, 4,434 (90.4%) were peripheral. By the end of the study, there were significant improvements in processes, compared with the preintervention period, including accurate documentation of dressing (from 442 cases [38%] to 718 cases [59%]; P < .0001), catheter dressing being intact (from 968 cases [88.5%] to 1,024 cases [95.2%]; P < .0001), and correct demonstration of scrubbing the hub before infusion (from 161 demonstrations [54%] to 316 demonstrations [95%]; P < .0001). There was a significant reduction in PVC-associated bloodstream infection, from 2.2 cases per 10,000 patient-days during the preintervention period (5 cases) to 0.44 cases per 10,000 patient days during the 3 intervention periods (3 cases; P = .016).
  
  
  CONCLUSIONS
  Education and real-time feedback to nurses increases and sustains compliance with processes to reduce the risk of infection from PVCs.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, Michigan 48236, USA. mohamad.fakih@stjohn.org
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: Karen
authors.initials: K
authors.lastname: Jones
authors.forename: Janice E
authors.initials: JE
authors.lastname: Rey
authors.forename: Dorine
authors.initials: D
authors.lastname: Berriel-Cass
authors.forename: Tatyana
authors.initials: T
authors.lastname: Kalinicheva
authors.forename: Susanna
authors.initials: S
authors.lastname: Szpunar
authors.forename: Louis D
authors.initials: LD
authors.lastname: Saravolatz
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D002406:Catheterization, Peripheral / Q000592:standards*; D005246:Feedback; D006784:Hospitals, Teaching; D006801:Humans; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*