Expanded use, updated guidance and push for consistent language among changes in 2021 Infusion Therapy Standards of Practice

Clinician wearing respiratory protection adjusting IV bag

Every five years, the Infusion Nurses Society (INS) releases updated, peer-reviewed standards that reflect the latest evidence to define and develop organizational infusion-based policies and best practices for all clinical settings. Released in mid-January, the 2021 Infusion Therapy Standards of Practice1 are among the most comprehensive and global – with more than 2,500 cited references and 120 reviewers representing 30 countries.

It would be impossible to summarize all the noteworthy updates from the 230-page document in a single article, but in the initial review conducted by 3M’s application engineers, registered nurses with vascular access-board certification, here are few of the topics that stuck out:

Expanded use of chlorhexidine-impregnated dressings

The 2016 standards noted the importance of chlorhexidine-impregnated dressings in reducing infection risk for patients with central venous access devices (CVADs). Now the benefits of chlorhexidine-impregnated dressings for use with short-term, nontunneled CVADs have met the highest level of evidence (Level I) with expanded usage recommended for more patients
(18 years or older) and more catheter types, including arterial, epidural, dialysis and implanted ports. View Standard 50, pg. S154; Standard 56, pg. S172; Standard 29, pg. S89; and Standard 28, pg. S87 for complete guidance.

Updated guidance for needleless connector disinfection

To reduce the introduction of intraluminal microbes via needleless connectors, the 2021 standards recommend either active disinfection with a 70% isopropyl alcohol or alcohol-based chlorhexidine swab pad or passive disinfection with disinfecting caps. Both active disinfection with alcohol-based chlorhexidine gluconate pads and passive disinfection with disinfecting caps were associated with lower rates of catheter-associated bloodstream infection (CABSI), while 70% isopropyl alcohol (IPA) swabs were found to be least effective based on a meta-analysis of quasi-experimental studies. View Standard 36, pg. S105 for complete guidance.

Expanded recommendations for integrated or dedicated securement products

These new standards make it clear that inadequate vascular access device (VAD) securement creates risk for clinically significant complications that could result in premature device removal. In addition to specific standards highlighting the need for proper securement, the authors also acknowledged the importance of assessing for the risk of catheter-associated skin injury (CASI) when utilizing securement methods. View Standard 38, pg. S108; Standard 55, pg. S168 for complete guidance.

Standardizing language for global consistency

PLABSI, CLABSI and CRBSI are all categories of bloodstream infection (BSI) commonly used in research and practice today. The authors recognize there are multiple catheter types which may cause a catheter-related BSI, and all can have detrimental effects on patients. Therefore, they now recommend using catheter-associated bloodstream infection (CABSI) for any infection stemming from either peripheral intravenous catheters (PIVCs) and/or CVADs. View Glossary, pg. S203 for the full definition.

Additionally, the authors recommend using catheter-associated skin injury (CASI) to discuss any localized skin damage around the vascular access device site, including drainage and erythema in the underlying area of a dressing. Also acknowledging that skin damage may be caused by more than adhesives – commonly referred to as Medical Adhesive-Related Skin Injury, or MARSI. View Glossary, pg. S204 for the full definition.

Also, guidance to reduce the risk of skin damage was strengthened, with more specificity on the ideal characteristics of a skin barrier product. It is now recommended to use a sterile, alcohol-free skin barrier that is compatible with an antiseptic solution to protect at-risk skin.
View Standard 42, pg. S120 for full guidance.

Increased focus on broader infection prevention

While the authors started work on the 2021 standards two years before the global pandemic, the increased focus on expanding standard precautions to include fit-tested certified N95 or higher respirators and additional hand hygiene protocols to prevent cross-contamination is a timely and important step for clinician and patient safety. View Standard 19, S58; and Standard 17, pg. S54 for complete guidance. Want more highlights and takeaways from the 2021 Infusion Therapy Standards of Practice?

Join us for a series of webinars with Lisa Gorski, MS, RN, HHCNS-BC, CRNI®, FAAN, chairperson of the INS Standards Committee. Registration is now open for the live events on February 23 and March 2nd.

1. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(suppl 1):S1-S224. doi:10.1097/NAN.0000000000000396

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