A collaborative approach for patient safety

The last 18 months have been the most challenging time for infection prevention and control teams (IPCTs) across the globe. The battle against SARS Cov2 has been relentless and teams have worked tirelessly to advise and support their colleagues. This editorial focuses on invasive device related infections, which continue to be of concern with some units reporting increased infections during the pandemic (Fakih et al., 2021).

Healthcare-associated infections (HCAIs) remain a threat to patient safety with an estimated 8.9 million cases per year in European hospitals and long-term care facilities (Suetens et al., 2018). Of these HCAIs, around 30% of the infections are resistant to antibiotics (Suetens et al., 2018) and therefore more difficult to treat and associated with a higher mortality. Effective infection prevention and control measures are vitally important in the control of antimicrobial resistance (AMR) (WHO, 2017). Catheter-associated urinary tract infection (CAUTI) and vascular access device (VAD)-associated blood stream infection (BSI) are the most common device-related HCAIs and are often preventable (Quinn et al., 2019).

The Infection Prevention Society and BD-Becton Dickinson together with the National Infusion and Vascular Access Society (NIVAS), Association of Safe Aseptic Practice (ASAP), British Association of Urological Nurses (BAUN) and Association for Continence Advice (ACA) launched the Device Related Infection Prevention Practice Collaborative (DRIPP) in April 2019. The aim of the collaborative is to spread best practice, reduce infections and improve outcomes for patients with urinary catheters (UCs) and intravascular devices (VADs). The work of the collaborative is to develop resources to support evidence-based best practice in the management of these devices and to reduce variation and inconsistency in the delivery of care to patients with a VAD or UC. These resources are designed to be practical and user-focused and are being developed by clinical experts in infection prevention and control from IPS and our other partner professional societies who have expertise in managing patients with such devices. Resources are informed by evidence-based guidance and tested to ensure that they are fit for purpose.

The first DRIPP engagement workshop was held in April 2019 and attended by 75 healthcare practitioners and representatives of our partner organisations. This workshop identified key challenges and gaps in managing VAD and UC safely. Themes that emerged were variation and inconsistencies in training, competencies, documentation, surveillance, aseptic technique and maintenance. These have now formed the focus of the VAD and UC collaborative teams’ activity in planning the development of resources and educational events.

Both VAD and UC pathways have been developed. The VAD resources include a surveillance guide which is not intended to replace national guidance (Public Health England, 2018) but recognises the importance of surveillance as a critical component of successful infection prevention and control programmes (Wilson, 2018). This surveillance guide has been developed to be simple to follow with clear definitions of a VAD-related BSI. It will enable the collection of peripheral intravenous catheter (PIVC) as well and central venous catheter BSI data with options to share the data in simple form as ‘days between’ infection where line data is not available. This will allow a ward manager or a specialist nurse to measure and monitor their local situation and importantly measure the success of their improvement work.

Using a modified Delphi approach (Okoli and Pawlowski, 2004), the VAD resources have been shared with the wider membership of the IPS, NIVAS, and ASAP through a virtual workshop allowing the participants to provide their expertise in the shaping of the resources. This virtual event also created discussion on how best these resources can be used in practice to improve both patient safety and patient experience.

Moving forward with the DRIPP collaboration the care bundles and pathways will be finalised in preparation for a launch event planned for later in 2021. This event is targeted at clinical staff and specialist practitioners and will consider how to implement the resources into practice using quality improvement methodology along with human factors and behaviour change techniques. There is evidence that having involvement of frontline staff to make changes opposed to top-down approach provides more sustainable improvement (Health Foundation, 2016) and we consider that having this frontline engagement will have the greatest benefit.

The use of quality improvement methods is more likely to achieve sustainable changes rather than changes imposed on clinical teams (Wilson, 2018). Fundamental to any quality improvement programme is establish measures to demonstrate improvements in practice (Institute for Healthcare Improvement, 2021). Without measurement, as quoted by Deming below, it is hard to quantify improvement, therefore it is hoped that the VAD surveillance guidance will enable healthcare staff to collect surveillance data as part of their improvement journey using the UC and VAD care bundles and pathways.

“Without data, you are just another person with an opinion”

W. Edward Deming

The DRIPP collaboration is an ongoing project and not time limited. The ultimate measure of the success of this collaboration will be the reduction of HCAIs related to UCs and VADs and to this end we hope many healthcare staff will utilise the resources and tools. All draft and finalised resources are available on the DRIPP website https://dripp.org.uk with links to previous events and forthcoming events.