A 210-bed community hospital experienced 13 MRSA bacteremia events from July 2017 - June 2019. Among those infections, 46.2% were associated with the use of a PIV. Review of MRSA bacteremia infections identified a lack of standardized prevention measures in patients with PIVs.

A multidisciplinary team was assembled consisting of Infection Prevention (IP), nursing, anesthesia, and Emergency Medical Services (EMS) to create and implement a PIV bundle. The bundle included labeling, dating, and assessing intact, clean dressings. Following bundle development, education was conducted across the hospital via skills fair with hands-on training and roving in-services to ensure 90% of affected staff were reached. IP collected pre-intervention data and bundle audit data weekly to monitor improvement. During audits, the IP performed just-in time education and feedback on bundle non-compliance. PIV-bacteremia prevention education was incorporated into orientation for new nurses. Additional education was conducted with Anesthesia and EMS providers on PIV insertion technique and infection prevention processes.

Baseline compliance with PIV-bundle components was 13.6% and increased to 69.0% in December of 2019 when the project ended. Dressing cleanliness increased from 66.0% in the baseline period to 88.7% Current data in December 2021 indicates an overall PIV bundle compliance rate of 80.6% demonstrating sustainability in the intervention. PIV-associated MRSA bacteremia decreased from 1.04 infections/10,000 patient days to 0 infections/10,000 patient days (p = 0.008).

PIV-associated bacteremia can be a major contributor to overall MRSA bacteremia. A comprehensive PIV bundle with stakeholder engagement is an effective intervention to reduce MRSA-bacteremia. Improving PIV maintenance practices reduces MRSA bacteremia.