Dr. Mermel's research spotlights IV infection risk

October 10, 2017

Each year, about 200 million adults needing medical intervention in the United States have an IV inserted into their arm to deliver vital fluids, nutrients and medicines.

These "peripheral intravenous catheters" play a critical role in a patient's care, but a small percentage of patients can acquire serious bloodstream infections.

New research by Leonard Mermel, D.O., FACP, FIDSA, FSHEA, is putting a spotlight on such complications as well as the need to follow best practice for prevention. Dr. Mermel is medical director of the epidemiology and infection control department at Rhode Island Hospital,

Peripheral IVs "are some of the most commonly utilized medical devices in healthcare settings" and they could be responsible for "several thousand bloodstream infections each year in the United States," said Dr. Mermel.

Dr. Mermel recently conducted a systematic review of numerous studies on infections relating to peripheral intravenous catheters.He knew that a great deal of attention has been focused over the past couple of decades on the risks of central venous catheters ("central lines"), which are typically inserted into the neck or chest of a patient to deliver medicine into a vein near the heart. Infections from these are now monitored closely in the United States and many other countries.

But Dr. Mermel thought more needed to be gleaned from existing research on the risks of peripheral IVs, which are inserted into a vein near the surface of the skin, typically in the arm.

He found that of the approximately 200 million peripheral venous catheters inserted into adult patients in the United States every year, the incidence of bloodstream infection is about 0.18 percent (i.e.,close to two such infections for every 1,000 of these catheters inserted). 

As a result, he said, "There are likely many patients who develop bloodstream infections (i.e. blood poisoning) from these devices."

Dr. Mermel found that the risk of infection from central lines is 2 to 64 times greater than for peripheral catheters. Still, with 330 million peripheral IVs purchased in the United States each year – and one-fifth of their insertions failing and requiring successive attempts – the numbers are still sobering.

He hopes that his study, published August 9, 2017 online ahead of print in Clinical Infectious Diseases will raise awareness of the problem and encourage medical institutions to take steps to better monitor and prevent such infections. His study was the subject of a report on WJAR-TV Channel 10 in Rhode Island.

"It is hoped that the data presented in the published article will serve as a wake-up call leading to national and international efforts aimed at implementing preventive strategies known to reduce such risk in future patients and to reduce the variability of practice regarding  insertion and maintenance of peripheral IVs," Mermel concluded.

Dr. Mermel suggests that medical institutions:
•    Replace peripheral IVs inserted under emergent conditions
•    Strive to limit how long peripheral IVs remain inserted to no more than three to four days in adult patients
•    Conduct daily inspections of the IV insertion site
•    Justify continued need for catheterization and to remove idle catheters

Dr. Mermel, a professor of medicine at the Warren Alpert Medical School of Brown University, has co-authored over 250 articles, text chapters and abstracts on infection control and infectious diseases. He lectures and teaches internationally.  His research interest is prevention of healthcare-associated infections.