Infusion set changes could save time, money and the environment
Extending the life of infusion sets has the potential to save money and reduce the environmental footprint of hospitals while still managing infection risk.
According to Professor Claire Rickard from University of Queensland’s School of Nursing, Midwifery and Social Work, three days could be added to the life of infusion sets while still preventing bloodstream infections in adults and children.
“Infusion sets, including plastic tubing, fluid bags and medications are currently replaced every four days to prevent bloodstream infections, but it requires substantial skilled nursing time and creates large amounts of plastic waste,” Professor Rickard said.
“We found replacing infusion sets at four days made absolutely no difference to infection risk, compared to waiting seven days.”
Professor Rickard believes seven days is the ideal amount of time, as nurses change dressings weekly so “it’s a good prompt”, and anything longer raises questions regarding the robustness of the tubing.
She said this research could help standardise procedures regarding infusion sets acknowledging that different hospitals were already replacing them at different times such as every second day, three times a week and “some were already pushing it out to a week”.
Annually, Professor Rickard said by extending the time between replacing infusion sets “this could lead to $15 million in savings in Queensland alone”.
Additional benefits include a reduction in environmental waste with estimates suggesting hospitals generate half a kilogram a day of toxic waste per hospital bed and 2.5kg of non-hazardous waste.
The Australian National Health and Medical Research Council-funded study was one of the largest nursing-led clinical trials undertaken, with almost 3,000 patients participating at 10 Australian hospital partners of the Alliance for Vascular Access Teaching and Research.
Patients were assessed for infections, mortality and adverse events, while infusion kits were tested for bacteria and other microorganisms.
“We used new criteria to diagnose whether bloodstream infections in cancer patients with catheters might be coming from their gut,” Professor Rickard said. “Using this method, we halved patient numbers diagnosed with catheter bloodstream infections in both study groups.
“Rather than disposing of masses of infusion equipment, regular hand hygiene by nurses and doctors, cleaning patients’ skin and injection connectors with antiseptics, and removing catheters as soon as possible are effective ways to prevent intravenous catheter infections.”
The research also highlighted that a type of connector called a three-way stopcock was most likely contaminated with bacteria, “which puts their use into question”. However, the results did not surprise Professor Rickard.
“Other studies highlighted they are a higher risk item and the way they are used is there’s a lot of handling … a lot of opportunity to touch and contaminate the part.”
While the connector is quite common in Australia and other countries, Professor Rickard said if hospitals are ready to get rid of the part there are other products available, it would just be a case of educating staff on their use.
Led by Professor Rickard, based at the Royal Brisbane and Women’s Hospital, the study was co-authored by researchers from UQ’s School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, and School of Medicine, along with researchers with links to 19 other research organisations.
Results were published in The Lancet