A cross sectional observational study

https://doi.org/10.1016/j.mjafi.2018.04.004Get rights and content

Abstract

Background

The use of intravenous (IV) cannulas is an integral part of patient care in hospitals. These intravenous cannulas are a potential route for microorganisms to enter the blood streamresulting in a variety of local or systemic infections. Studies showing the actual prevalence of colonization of peripheral IV cannulas and its role in BSI are lacking. Hence, this study was aimed to estimate the prevalence of colonization of the injection ports of peripheral IV cannulas.

Methods

This cross sectional study was conducted on patients admitted in ICU and wards in an 800 bedded tertiary care hospital. Swabs were taken from lumens of peripheral IV cannulas and cultured. Patient demographic data and practices followed for maintenance of IV line were noted.

Results

A total of 196 injection port samples were taken, out of which 11 tested positive for microbial growth (5.61%). Staphylococcus aureus was the predominant organism contributing 64% of the microbial growth. A significant association was seen between presence of local signs, old age and positive cultures. Flushing IV cannula every 6 h was associated with negative cultures.

Conclusion

Peripheral IV cannulation has significant potential for microbial contamination and is largely ignored. Most of the risk factors associated with growth of microorganisms in the injection ports of peripheral intravenous cannulas (which has a potential to cause catheter-related blood stream infections) can be prevented by improving protocols for management. To prevent infection from occurring, practitioners should be educated and trained about the care and management of IV.

Introduction

The use of intravenous (IV) cannulas is an integral part of patient care in hospitals. These devices are used for the administration of fluids, nutrients, IV medications, blood products and for procuring blood specimens. Population studies have shown that more than 70% of inpatients need peripheral IV cannulas.1, 2 In our 800-bedded hospital almost two and a half lakh peripheral IV cannulas are used per year. These IV cannulas are a potential route for microorganisms to enter the blood stream resulting in a variety of local or systemic infections. As compared to central venous catheters, the incidence of local or blood stream infections (BSI) associated with peripheral IV cannulas are usually low.1, 2 However it can considerably prolong hospital stay, morbidity and mortality due to increased frequency of usage.

Microorganisms causing vascular catheter-related sepsis gain access to the bloodstream through either the skin at the catheter insertion site or through the catheter hub. There is enough evidence that the greatest risk for contamination of the IV catheters after insertion is the access hub with 30–50% being contaminated in normal patient use, whether adults or neonates.3, 4, 5, 6 There is another school of thought that colonization of valved injection side ports of IV cannulas does not contribute significantly to BSI. Barring a couple of studies, which were done in peripheral IV cannulas, most of these studies focused on central venous catheters.7, 9 Studies showing the actual prevalence of colonization of peripheral IV cannulas and its role in BSI are lacking.

The primary objective of the study was to estimate the prevalence of colonization of the injection ports of peripheral IV cannulas. We assumed that if the injection port is contaminated then certain microorganisms might migrate endo-luminally and cause blood stream infection. Our secondary objective was to analyze the prevalent practices in a tertiary care hospital and study their association with injection port colonization.

Materials and methods

This cross sectional study was conducted on patients admitted in ICU and acute surgical, medical and Obstetrics and Gynecology wards in an 800 bedded tertiary care center after obtaining ethical clearance from the institutional ethics committee. The participants were adult inpatients over 18 years of age, who needed peripheral IV therapy. Informed consent was taken from the participants prior to the study. Patients, who needed peripheral venous access for IV therapy, had a peripheral IV cannula

Results

A total of 196 injection port samples were taken, out of which 11 tested positive for microbial growth 5.61% (3.16–9.77%). The median time for the inserted peripheral cannula was 55 h (range 48–108 h). The demographic profile of patients is given in Table 1. The median age of the population was 55 years. Older Age (>55 years) was associated with microbial growth (p = 0.0140). However, there was no significant association between sex and injection port contamination (p > 0.05). The prevalent practices

Discussion

Out of the 196 injection port samples taken, 5.61% tested positive for microbial growth. Considering that approximately 250,000 peripheral IV cannulae are inserted every year in our hospital, it would translate into a huge number annually. Previous studies have shown the incidence of blood stream infections due to peripheral IV cannulas to be 0.1–0.2%.1 There is no literature which gives prevalence of microbial growth at injection ports only.

In our study, S. aureus was grown in 63.6% of the samples.