ISR 65 - Impact of PIV Site Rotation Policies on PLABSI Rates May Be Biased Due to COVID-19 Surge

Background: Infusion Nurses Society recommends peripheral intravenous (PIV) lines to remain in place until clinically indicated, but some system hospitals did not change their policy for removal of PIV until 2019 or later. The objective was to evaluate the impact of changing the PIV removal practice on peripheral line associated bloodstream infections (PLABSI).

Methods: In a healthcare system of 11 hospitals, seven changed their practice to remove PIV removal practice when clinically indicated at differing times during the study period. Hospitals used standardized definitions to identify PLABSI, in a surveillance method like National Healthcare Safety Network definitions for bloodstream infections. Rates of infections, use of contract nursing, and comparison of COVID-19 surges were compared between facilities using chi-square analysis and linear regression.

Results: Combining data for all institutions prior to policy change, was an overall PLABSI rate of 0.16 /1000 peripheral line days (PLD); the rate increased 55% after policy change (rate 0.25/1000 PLD, p>0.01). Hospitals that did not change PIV removal practice showed no significant rate change during the study period (rate 0.13/1000 PLD overall). Facilities with a practice change were noted to have a statistically significant increase during the first COVID-19 surges in the region (rate 0.26, p< 0.01), and a return to rates at baseline in 2022 (rate 0.21, p 0.59). Use of agency nurses increased more than twice as much in these hospitals, as compared to those that continued with a practice of removal at 96 hours (linear regression slope 1.68 compared to 0.85).

Conclusions: Data analyses raised concerns that the change in PIV rotation policy led to a significant increase in PLABSI. COVID-19 surges and agency nurse use may have confounded this association. Further research is needed to understand the impact on PLABSI data comparing PIV removal policies at 96 hours and clinically indicated outside of a COVID-19 surge.