Marie Cleary-Fishman (Host): Peripheral IV catheters or PIVCs have long been considered routine and low risk. However, emerging evidence shows PIVC-related infections are more common than many realize with serious consequences for patient safety. That's why leading health systems are now expanding infection prevention programs beyond center lines, to also include PIVCs.

 Hello and welcome to AHA Bringing Value series from the American Hospital Association. In this podcast series, we speak with AHA business partners, check in on their healthcare initiatives, and learn how they support AHA hospitals and health system members. I am Marie Cleary-Fishman, Senior Advisor for the Health Research and Educational Trust at the AHA.

Today, I am joined by Aryeh Feldheim, Infection Preventionist at University of California San Diego Health, and Kris Hunter, medical liaison at Solventum. In this episode, we'll explore how hospitals are strengthening patient safety, reducing avoidable costs, and building a culture where every IV line and every detail matters. Aryeh and Kris, welcome to the podcast.

Aryeh Feldheim, MPH: Thanks for having us.

Kris Hunter, BSN: Yeah. Thank you.

Host: Our pleasure. We've all seen that PIVCs are everywhere. They're among the most common devices used in hospitals with multiple clinicians inserting them daily. Why do we no longer view them as low risk?

Aryeh Feldheim, MPH: Yeah. We've seen a lot of emerging literature that has shown that PIVs pose a risk for bloodstream infection in patients similar to central lines. And historically, we've always tracked central lines for bloodstream infections. And that's always been our focus of surveillance. And more and more literature is coming out showing that PIVs pose a risk as well. And while the rates are a bit different, PIVs having a smaller bloodstream infection rate, the sheer volume of PIVs pose a risk to our patients. And we should really start paying attention to them.

Kris Hunter, BSN: Yeah, that's a great point. Like, when you look at the literature, most of it shows that the rate of infection is well less than 1%. We're talking 0.1%, 0.2% or so of peripheral IVs. And that looks very, very rare. But when you calculate it out, based on the sheer volume of peripheral IVs, that's generally about one bloodstream infection for every 555th peripheral IVs, which for many hospitals, if you're greater than, like, let's say 200 beds, that might be occurring once or twice a week—a week. And when you think about CLABSI, we think about in terms of once or twice a year, once or twice a quarter, maybe at most once or twice a month. And this is something that is being counted by the days.

Now, more than that, there's also a mortality rate associated with peripheral IVs and bloodstream infections. Most literature and vascular access shows about a 20% mortality rate on average for vascular access bloodstream infections. If we're going to be really conservative though, and I like to be, it looks about 13%. Thirteen percent is a huge mortality rate when you compare it to other kind of clinical issues and then you can look at the cost of it. A recent literature piece showed that a conservative cost for peripheral IV bloodstream infection, if the patient doesn't go to the ICU, costs a hospital about $34,000 conservative.

Host: That's some very impressive information and certainly helps us begin to understand why we are looking at these more closely. So, we've shifted to expanding our bloodstream infection surveillance and reporting beyond the central lines. And what do we need to let our healthcare teams know specifically about paying much closer attention to this?

I mean, I'm a long-term nurse ready to hit the retirement button. And, you know, I certainly remember the days where we started these and didn't necessarily think so much about them in this way. So, give us a little more about the bloodstream infection surveillance. And you've given us some of the statistics, but how are we improving that and doing more there?

Kris Hunter, BSN: So, what a lot of people are aware of is HOB, it's kind of been the big talking point in the last couple years or so. And that's a part of what's known as the DMI program, the data modernization program, kind of falling within that spectrum. And this is a big program to update how the United States kind of manages and reports healthcare-related information.

Now, HOB in itself, there's a perception that it's coming, that it's coming down the road. Now, that's not really true because it's here today. It's here today. The financial penalties for HOB are actually 43 years old today. What is coming is having to publicly report those infections. So, under the DMI right now, they're doing the kind of beta and alpha testing for that. And what looks to be good money is showing is probably beginning of 2028. We're going to kind of start the very initial process of going public live throughout the country. But right now, there's just about 18, 20 hospitals or so that are in beta testing for this right now, primarily looking at the FHIR system, FHIR, and validating that the software system on tracking and reporting these is working accurately.

Host: Aryeh, your health system's been working to both track and to prevent PIVC-related infections. As Kris just mentioned, given the sheer volume of PIVCs, what's your advice to other hospitals on how to start identifying whether or not they have a problem? And then, what steps has your own team taken that have really made the biggest difference in preventing those infections?

Aryeh Feldheim, MPH: Yeah, great. Great question. And this can be sort of a big task if maybe this is not on your radar. So, what I like to say is to break it down into three major components, materials, informatics, and culture—MIC, as a just kind of a short form acronym to remember that. So, materials, you want to be thinking about what sort of dressings are you using on your peripheral IVs or any of your lines. The current guidelines recommend the use of CHG for your central lines. And the literature, I think, is now catching up to other vascular access devices. And the recommendation is to consider using CHG to protect the insertion site, all of your lines.

And so at UCSD, we have been using a CHG product on our peripheral IVs since about 2016. And we are now using them for our peripheral IVs, and in the process of rolling them out for our central lines. So, that's from the materials perspective. Informatics, If you are supported by a major EMR—UCSD, we're on Epic—you can run reports and look at your patients that do not have any central lines, but only have peripheral IVs and start to do surveillance. That way, you can track bloodstream infections by simply applying the NHSN definitions for central line-associated bloodstream infection and just applying them to your peripheral IVs just as a starting point to see where you're at.

And then, most importantly, culture. If you don't have the buy-in from your teams, from your leaders, from your bedside nurses that are actually caring for these patients, it's very difficult to adopt any of these processes. So really, getting the buy-in from your leadership and from your nursing teams is extremely important. And a big component of that is, while you're rounding, doing your device rounds, your multidisciplinary rounds, are you talking about peripheral IVs? Are you talking about all of your vascular access devices? If your nurse leaders are aware of these things, that's wonderful. But does the bedside nurse feel empowered to make these decisions and to say, "Okay, is that peripheral IV necessary? Can we consolidate some of these lines here?" Everyone on the team needs to feel empowered to make these decisions. And everyone needs to be thinking about these things, not just the folks at the top. So, thinking about your materials, your informatics, and your culture will really set you up for success here.

Host: Yeah. That's great advice. I think certainly that culture piece is critical. We see that across quality and safety, all over, that culture of improvement has to be from the frontline through the organization. So really, really good comments. Kris, for organizations who are looking to start or to advance their PIVC improvement journey, how can  Solventum help them identify the right solutions?

Kris Hunter, BSN: So, there's a couple different ways to first approach this. Now, the first thing I commonly hear from hospitals is that they're not aware of their issue. They're so hyper-focused on things like CLABSI, CAUTI, and things like that, that they're not aware of this issue. And so, you don't have to take my word for it. Look in your own data for this, and it's not that difficult. Look at your patients with positive blood cultures on, like, let's say day three, day four of admission, subtract your secondary infections. Why are there so many patients who are getting these bloodstream infections from no known source? Maybe, possibly it could be from the most common invasive medical device in the world, the peripheral IV. But look at your own data first. This can be daunting though, and getting the education can be difficult and changing the culture can be a challenge. And that's the first part of where I think Solventum can really help. Reach out to us. We provide education in this space. We're more than happy to come in provide lunch and learns or different podium presentations or work with your clinicians one-on-one, and go work with your frontline staff, work with your CMOs to help recognize this issue and kind of really elevate it.

Now, the second part of that is really going towards the materials of it. And this is a story of equity. When you think about vascular access, we treat all vascular catheters except for one the same. We treat PICC central lines, implanted ports, hemodialysis catheters. Any type of vascular access device generally gets the same basic protocols. It's like, you know, you're using sterile gloves for the insertion, you are using disinfecting caps, you're using antimicrobial dressings on all of these catheters. But there's one type of vascular catheter that is segregated from all the rest. And we anticipated that the outcomes would be the same. And the question is why are we segregating one type of vascular catheter from all the rest?

And so, when you think about reducing infections with like PICCs and central lines, we know there's two major classes of technology that have proven to reduce the risk of infection. That's disinfecting caps and the antimicrobial drugs. It's what you use on your PICCs and central lines. So, the question is why are we artificially segregating peripheral IVs from the rest of the vascular catheters?

Host: So, I think, finally, I wonder if there's any bit of guidance for our AHA members as they look to expand their infection prevention programs across all IV lines versus, as you just mentioned, Kris segregating or segmenting into different types. And I would add one question here. I'm going to be pinning a new nurse in a couple of weeks, and I would ask you both what advice would you give to that new nurse, as well as suggestions to our members. But what would you tell that new nurse? In their practice, what would make them be part of this culture early on?

Kris Hunter, BSN: What I would tell that new nurse is, first of all, critically, think about what you are doing. When you approach a PICC, for example, you're going to approach the blue lumen the same way you're going to approach the red lumen. It's all in the same catheter. You're going to generally approach a central line the same way you're going to approach that PICC. When it comes to all vascular catheters, you should use the same kind of critical thinking and same level of care with all of them.

What is good for one catheter is good for another catheter. So, really be aware of that. Be aware of the outcomes the data exists within your hospital. Most all hospitals I've talked to about this pull up the reports within one to two minutes. It's pretty straightforward. Be aware that there is an issue. And I think I'm borrowing that from AA. In order to change culture and in order to change yourself, you first have to recognize that there is a problem. And we had that recent trailblazer article recently that helps discuss some of this. Reach out. There's information out there That is available to you to get educated on this topic.

Aryeh Feldheim, MPH: I'll add to that, if I'm speaking to this nurse, the message that I want to send home is that, when it comes to these vascular access devices, there's no free lunch here. There's no free lunch. What I mean by that is that when you are caring for a patient that might have a central line in the IJ region, and then the patient has a PICC, and then they have three PIVs and only one of them has been used for infusion in the last 24 hours, and the other two have just been sitting in place dormant for the last couple days, there's no free lunch. Those catheters matter as well.

And so, to expand on Kris's point, use that critical thinking ability that you have as a nurse and feel empowered to assess these devices for their indication at least on a daily basis and make the determination. It's within your scope to say, "Okay, this PIV is no longer necessary. I can consolidate here and you're going to do those things." And you should feel empowered to do so as a nurse. And we want to really encourage that culture of thinking critically about these devices, looking at these peripheral IVs with an eye towards patient safety, knowing that they do pose a risk, they're not just sitting there doing nothing. And that you should feel empowered to do something about them and assess that indication on a daily basis.

Host: Thank you. I love that guidance for empowerment and really looking at this in a holistic way. I think you've done a great job. As a person who's been in Quality for a very long part of my career, I am always quoted for saying structure plus process gives you the outcome you want to see. And you've both done a great job of demonstrating that. Dr. Donabedian would be very pleased. So, thank you so much for sharing this information with our members today. Both of our guests, Kris and Aryeh, we really appreciate you joining this podcast and for sharing your insights with our members. For our listeners, if you'd like to learn more about Solventum, please visit solventum.com.

This has been AHA's Bringing Value series, brought to you by the American Hospital Association. Thank you so much for listening.