Maintaining Dressing Integrity to Prevent Infection
Maintaining clean, dry, intact dressings over vascular access devices (VADs) is fundamental to site care. The 2021 Infusion Therapy Standards of Practice recommend that transparent dressings be changed at least every 7 days. However, if the dressing is disrupted ‐ meaning loose, wet, or soiled – the standards recommend it be changed immediately. While it is essential to replace dressings when indicated, unnecessary changes can be costly and detrimental to the patient.¹
Dressing disruption is one of the primary factors behind non-routine dressing changes,¹ and multiple dressing disruptions raise the risk of catheter‐related bloodstream infection (CRBSI).² It is clear maintaining dressing integrity is an important factor in preventing infection.
Maintaining Skin Integrity to Prevent MARSI
Intact skin acts as a physical barrier to pathogens. Removal of adhesive dressings causes stripping of the outermost epidermal layer, which creates a route for infection. Maintaining vascular device dressing integrity helps prevent CLABSI and decreases possibility of medical adhesive‐related skin injury (MARSI) that is often associated with multiple dressing changes.¹
Improving VAD Dressing Integrity Without Increasing MARSI Risk
Michelle DeVries and colleagues performed a study to investigate the impact of both educational and material additions to care bundles, aiming to improve peripheral IV dressing integrity without raising risk of MARSI. The goal was at least 80% of evaluated dressings remaining intact on day 7. “Intact” dressings were defined as all 4 corners adhered to the skin without reinforcement.¹ Before new practices were implemented, only 55% of evaluated dressings remained intact at assessment.
Four dressing protocols were evaluated. In the best performing protocol, results showed that after gum mastic liquid adhesive was implemented into care bundles¹:
- The percentage of fully intact dressings increased from 55% to 93%
- Insertion site exposure decreased from 15% to 0%
After this project, a new dressing and gum mastic liquid adhesive combination was standardized along with revised education protocols. A comprehensive post‐implementation program for ongoing monitoring was developed. During the 18‐month period following the project, over 30,000 dressing sites were assessed. At the time of visual assessment, 96% of these dressings were found to be intact, and no dressing‐related skin injuries were reported.¹
When gum mastic adhesive was incorporated into PIV dressing kits, clinicians opted to evaluate its use for central line site care. Gum mastic adhesive was subsequently incorporated into central line dressing change kits as well. The organization has since adopted its use as standard practice for inpatients and emergency department patients anticipated to be admitted.¹
Access the full study here.
- DeVries M, Sarbenoff J, Scott N, et al. Improving vascular Access Dressing Integrity in the Acute Care Setting. J Wound Ostomy Continence Nurs. 2021;00(0):1‐6.
- Timsit, JF, Bouadma L, Ruckly S, Schwebel C, Garrouste‐Orgeas M, Bronchard R, Calvino‐Gunther S, Laupland K, Adrie C, Thuong M, Herault MC, Pease S, Arrault X, Lucet JC. Dressing disruption is a major risk factor for catheter‐related infections. Crit Care Med. 2012;40:1707‐14.