P009 - Picking the Right PICC: The Decision-making Process and Key Metrics to Review and Measure When Making the Switch

Purpose - What was the goal of the study?: To reduce the incidence of non-MBI CLABSIs in peripherally inserted central catheters (PICCs), implementations of an antimicrobial coated line, in combination with basic infection prevention bundle elements, was reviewed and implemented to improve hospital metrics.

Background - What was the problem? Why was it important?: In June 2021, an analysis of institutional CLABSI trends, indicated a significant number of CLABSIs were associated with PICCS. Current best practice guidelines recommend the use of antimicrobial coated central lines for hospitals with CLABSI rates above institutional goals, despite adherence with basic CLABSI prevention practices. After review of evidence-based recommendations to reduce CLABSI, the decision was made to trial antimicrobial coated PICCs. Inpatient provider teams with patients at highest risk for PICC CLABSIs were included in pre-trial planning, and trial guidelines were created in conjunction with institutional compliances officers. This widespread product trial included extensive data tracking, educational content development, and policy expansion.

As an institution, an average of 120 PICCs are placed/month, with over 95% placed at bedside by specially trained vascular access team (VAT) nurse clinicians. If VAT is unable to place at bedside, the PICC is placed by an interventional radiology (IR) provider under fluoroscopy. The nurse-led vascular access team placed antimicrobial coated PICCs in all eligible adult patients, excluding those with a Chlorohexidine allergy, while IR providers placed non-coated PICCs.

Results - What were the findings?: During the six-month product trial phase, from September 2021 to February 2022; 555 antimicrobial coated PICCs were placed by the VAT and 247 non-antimicrobial coated PICCs were placed by IR providers and at bedside by VAT on patients with chlorohexidine allergies. Of the 555 anti-microbial coated PICCs, only one developed a non-MBI CLABSI, while of the 274 non-coated PICCs placed, 11 developed non-MBI CLABSIs. Prior to implementation of antimicrobial coated PICCs, the institution averaged three adult non-MBI CLABSIs/month. This accounted for 47% of all adult non-MBI CLABSIs.

While implementation data collection is ongoing, early reports of trial data have found consistent reduction of non-MBI CLABSIs in PICCs. Other key metrics reviewed and measured included incidence of venous thrombosis, including the use of tissue plasminogen activator (tPA), infiltration, and dislodgement.

Conclusions - What do the final outcomes mean?: Combined with basic infection prevention bundle elements, the introduction of an antimicrobial coated PICC has been successful in significantly decreasing non-MBI CLABSI incidence in PICCs. With organizational recognition of trial success, the use of an antimicrobial coated central line has expanded to include the implementation of coated central venous catheters (CVCs). The implementation of coated CVCs will also include extensive data tracking, and educational content development, for both nursing and provider groups.