Addressing the Blind Spot of Peripheral IV Infections

By Matt Phillion

The new Guide to Preventing Catheter-Associated Bloodstream Infections has been generating conversation among infection preventionists following APIC 2025. CMS is eyeing Hospital-Onset Bacteremia (HOB) surveillance and hospitals are pushed even further to reduce preventable infections, and with this in mind the report highlights a critical blind spot in the industry: Peripheral IVs.

Peripheral IVs are the most frequently used vascular access device and yet are still largely overlooked in surveillance efforts.

To address this blind spot, infection prevention needs a system-level shift that evolves alongside patient care and quality measures. Meanwhile, new data drivers can have an impact on HOB surveillance in hospitals, while practical tools designed to reduce administrative burden can have a positive workforce impact going forward. But how did we get here, and how to we change?

“There’s a couple of things at play with this blind spot,” says DJ Shannon, MPH, CIC, VA- BC, FAPIC, guide author and infection prevention manager from Indianapolis, Indiana. “I don’t think it’s because anyone is actively choosing to ignore these devices. It’s really two-fold: First, we have a system in the U.S. where the federal government financially penalizes or reimburses based on CLABSI performance, so that’s where we’ll put our focus. There are potentially big dollars involved with poor performance, so it makes sense to focus there.”

But at the same time there are far more peripheral than central lines, Shannon notes.

“It’s a lot more work to really be able to evaluate our peripheral lines, both in terms of outcomes like bloodstream infections or maintenance practices,” he says. “If we start looking at all peripheral lines, that’s a lot of work and many hospitals are inadequately staffed for infection prevention departments.”

For many organizations, they can meet national requirements for these benchmarks but are held back from going far above and beyond simply because there aren’t enough people on hand to do the work.

Areas to improve

This doesn’t mean it’s all doom and gloom, Shannon notes.

“There are some practical ways to still give this issue some love and to shine light on our peripheral IVs without turning the faucet on full force,” he says. “From an epidemiological perspective, you don’t have to look at every device every day—do a subset. Only do 10% of devices or conduct surveillance monthly or quarterly.”

Capture some the data to approximate outcome performance and use it to guide, direct, and improve care, Shannon says.

With between 60% to 90% of patients needing one or more peripheral IVs, there is plenty of data to look at, Shannon explains.

“Is it too big a problem?” Shannon says. “The numbers are just staggering and that leads us to ask: How am I supposed to chip away at this mountain?”

This leads back to the second challenge at the core of this issue: Staffing.

“We’re putting expectations on our caregivers to do all the things required to take care of these patients, but instead of taking care of three patients you’re caring for four, or maybe your managers and leaders are taking on additional work that adds to their capacity so they have less time to do quality audits and rounding,” says Shannon. “The work still needs to be done and we have less people. We’re trying to figure out how we can use technology to make jobs more efficient.”

And the trick here is making sure the technology actually complements the work staff are doing rather than bogging it down.

As tools like ambient listening or automation for charting evolves, there ways organizations can use existing tactics to improve patient outcomes, Shannon notes.

“Something facilities can do today is to start looking at the way they care for their central lines and compare that to how they take care of their peripheral lines,” he says. “If they don’t look similar there’s an opportunity there. Central lines get a lot of care and love that other vascular access devices don’t. There are definitely opportunities for improvement where we can insert and maintain all our vascular access devices better to try to protect our patients.”

Infection prevention leads the charge

When it comes to who can push for these improvements in peripheral IV maintenance, the role falls strongly on the shoulders of the infection prevention profession, Shannon says.

“Our vascular access specialists are all over this. They already know what’s up,” he says. “We infection preventionists aren’t talking about it the same way vascular specialists are. It’s important to expand our view to prevent negative complications in our vascular access devices beyond central lines. If we can get that group mobilized, we can start to move the process forward.”

He suggests the industry would benefit from shifting the conversation from focusing on CLABSI and MRSA to all HOB.

“It is a huge shift, and a needed one,” he says. “This would allow us, and require us, to look at all the avenues that might cause harm in our patients we’re not looking at right now, like peripheral IV-associated infections or pneumonia. It’s not something every facility is looking at but it has a real patient impact.”

The HOB metric has been lingering, Shannon notes, and keeps getting kicked down the proverbial road, but changing this perspective could have a huge impact on patient care.

“It really opens the door for the quality department—quality, infection prevention, risk, even clinical nurse specialists—to really come together and have an opportunity to look at harm in a different way,” says Shannon. “Right now we look at harm in a very siloed approach. This patient has CLABSI, this patient has a pressure injury…different teams don’t necessarily talk to each other. But something like HOB, all of a sudden, those teams have to communicate.”

If a pressure injury is bad enough to cause a blood stream infection that then becomes an HOB, that brings skin experts into the infection prevention world where normally they would not have cross collaboration, Shannon explains.

“Collaborating across disciplines in ways we’re not currently doing will allow us to identify gaps in care that we’re not currently seeing,” he says. “It brings different disciplines and their perspectives together which would then hopefully improve those gaps, improve those outcomes, and lead to less burden on staff, less harm on the whole, which then leads to shorter lengths of stay. And that is good for everybody, getting those patients home faster and healthier.”

Shannon is optimistic this is an opportunity to impact healthcare and the patient experience in a positive way.

“I sometimes look at is as a mountain. Where we are now, there’s what we look at as part of federal requirements, and further up the mountain, there are additional harm events you look at and at the peak, you’ve got all patient harm,” he says. “In my heart, that’s where I want us to be. We should be looking at all patient harm and how to prevent it regardless of if it’s tied to federal dollars. I know we have to care about the money aspect, but I come here every day to prevent harm in patients, and I would love to see us as a whole move to a model where that’s our focus, where we’re looking at all harm.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.