Q&A: Infection Preventionists, Vascular Access Nurses Line Up

August 10, 2020

Maya Gossman, RN: “I tell people, I put tubes in veins, that’s what I do for a living. Anytime you break the skin and you place a tube into the bloodstream, that’s a huge risk for infection.”

Maya Gossman, RN, a vascular access nurse at Stillwater Medical Center in Stillwater, Oklahoma, knows firsthand the benefits of teaming up with an infection preventionist (IP). She works closely with the IP “to create policy, to share data, to stay up to date on best practice standards. We trial products together that we think might decrease infection risks.” Gossman discusses how much that cooperation means and also how COVID-19 might forever change the way vascular access is done.

Infection Control Today®: How can infection preventionists and vascular access specialists work together to get the best results?

Maya Gossman, RN: We are a community hospital. And we have 117 licensed beds. We have a small vascular access team. There’s just two of us on staff here that are vascular access specialists. But we do work closely with the physicians, with the nursing staff, and especially with the infection prevention nurse in order to best care for our patients’ vascular access needs. There are so many factors that go into vascular access as a specialty, but I feel like probably the most important is infection prevention because it affects so much else about their care. We do place devices directly into the bloodstream of our patients, which creates a conduit for infectious agents. So, we work with our infection prevention nurse to prevent any type of infection related to those vascular access devices. Specifically, here we work with her to create policy, to share data, to stay up to date on best practice standards. We trial products together that we think might decrease infection risks. She’s not officially a member of our team. But we’re blessed here at Stillwater to have a culture of teamwork and patient centered care that makes us all work really well together as a team.

ICT®: Just where do infection preventionists fit in vascular access efforts?

Gossman: I think that as we grow, an infection preventionist on the team would definitely be a benefit. We just started our team here two years ago. So, we’re kind of a baby team. We used to have a PICC team that we did PICC lines on the side and I was a part of that team. But we didn’t have a holistic vascular access focus. We would do a PICC line when needed. But there was nobody focusing on the peripheral IVs, the arterial lines. There was no daily rounding by specialists on the central lines or any of the lines. We formed that team two years ago. We’re just in the beginning stages and I think as we grow we definitely will have a place for an official infection preventionist on the team.

ICT®: When you call the infection preventionist in to help you with something, what is it that you ask for help with?

Gossman: We look at new devices. We look at new dressings; things that we think could help with decreasing infection. We actually don’t have any CLABSIs [central line-associated bloodstream infections] and we haven’t in five years, I believe. We’re very blessed here. We’re probably not the norm. I know in fact that we are not the norm. We mostly work at preventing a problem from happening. One of the things we did work together with when COVID hit was we were looking at how to prevent infection and also these lines that we’re placing in the patients are staying longer. Our COVID patients’ length of stay is longer than a normal patient. And in order to minimize exposure with staff, and save PPE, we were doing some things like placing the pumps farther away than we normally would from the patient. So, we looked at a device that we had actually been trialing and we went ahead and adopted a securement device. That’s a subcutaneous securement device for our PICCS and our central lines in order to make sure that line stays in place. Because every time a line comes out, and you have to place another line that increases your infection risk in that patient. We worked with her on that, and we’ve been using it with great success. Just things like that.

ICT®: It’s interesting that you say that the lines stay in longer for COVID patients? How much longer on average?

Gossman: I don’t have a number off the top of my head. But I know that our length of stay and the length in the beginning, we were intubating more because this was, as you know, new for everybody. And it was like being thrown into her warzone all of a sudden. We were intubating more in the beginning. And they would stay intubated for quite a while. They would need paralytics. And, sometimes they would need medications to help maintain their blood pressure. They would keep those lines longer and also need more invasive lines then what we normally would do.

ICT®: When was your biggest spike?

Gossman: Our biggest spike actually was in July. We had a little spike in March and then we didn’t have anything for quite a while, and then it picked back up at the end of June and into July.

ICT®: I understand that July 4 was a big weekend for people getting infected.

Gossman: Yes, we’re a college town as well. And a lot of our students came back. They had been gone and they came back because leases started June 1 on apartments. They came back into town and they weren’t the ones getting really ill, but they were spreading it quite a bit.

ICT®: COVID-19 is a virus and the other pathogens that you have to deal with, for the most part, are bacterial. Does that make your job more difficult?

Gossman: From a vascular access standpoint, it’s probably about the same. We just want to ensure good access for the medications that they need. And while they might not be needing antibiotics with a virus, you know, there are other medications that we have been giving. They may need fluids, they may need suppressors, the medications for when they’re intubated to sedate them, and paralytics. I don’t feel that there’s a big difference from our perspective.

ICT®: How can infection preventionists develop a better rapport with the vascular access team? What should motivate them to do that?

Gossman: I think that creating a good team is important for our patients and for our work relationships. Because when you have a teamwork atmosphere, you trust each other, you know that you’re always looking out for the best interests of the patients. So there’s none of the questioning, like, well, what’s your motivation? You know that everyone is working toward a common goal, and that’s to have the best outcomes for our patients in the end. To have them get out of the hospital and go back to their regular lives and health without any complications, without a longer length of stay due to an infection that was contracted here in the hospital. It makes everything run smoother for the patients, for the hospital. It can decrease cost, which you know, cost is always a factor in healthcare. If we can prevent the infections and place a single device…. That’s one of the focuses of vascular access is trying to place the right line in the patient at the right time the first time. To ensure that we don’t have to continue replacing IVs every two or three days. And then, six days into their stay, we decide, “Oh, they need a PICC line now because they need long-term antibiotics” or whatever reason. We try to get on that from the beginning and place that line in the beginning so it decreases costs. It increases patient satisfaction. Increases staff satisfaction because having an IV complication can derail your entire day as a floor nurse. I started on the medical floor. I understand what that’s like when you have a lot of overwhelming things going on, to have an IV complication come up can derail your entire morning. Working together all of us together, it’s really in the end just to get the patients back to health as quickly as possible.

ICT®: You have a great relationship with the infection preventionist there. Was that just chemistry or is it something that anybody can do, no matter who the two people are?

Gossman: I think that anybody can do it. I mean, maybe with a few exceptions, but I think that if we really keep the patients at the heart of everything that we do, and we set are our own feelings aside sometimes. There are people that everybody works with. Maybe they’re not your favorite person, your personalities don’t mesh. But as long as you keep the patience at the heart of what you do, I think everybody can develop that trust and that rapport.

ICT®: Is it logistically possible to have an infection preventionist as part of a vascular access team? Wouldn’t that take her away from other duties?

Gossman: I think that if there was an infection preventionist on the team, she would definitely have to focus on vascular access, at least part of the time. It is such a large specialty now. I mean, we have a very small focus, placing devices into the bloodstream. However, there are so many choices now. And there are so many factors that go into the device selection that we make. She would have to spend quite a bit of time focusing on that. For places like here, where we just have one infection control nurse who has so much to do, I mean, she is, especially with COVID, now overwhelmed with so many things to do, that to try and have her as an official member of our team at this point would probably not work. We would probably have to have more than one infection preventionist.

ICT®: Will there be permanent changes made to how vascular access teams operate as a result of COVID-19?

Gossman: I hope so. One of the things I’ve noticed with COVID—I don’t want to say it’s been a benefit for me, but a positive, I guess—is that we didn't have to report CLABSI anymore. Which as I said, we don’t have a problem here with CLABSI. However, I know some places, their physicians are so focused on preventing CLABSI that they are asked to place peripheral IVs sometimes in situations where a central line would be more warranted in order to prevent CLABSI. I strongly believe that any device that goes into the bloodstream is a risk for creating an infection that could be life threatening for that patient. I feel like we should look equally at all vascular access devices rather than putting so much focus on the central lines as infection sources. So COVID took that aspect away, for a little while at least. We’ve been able to place the most appropriate line that we feel the patient needs, regardless of what numbers we have to report.

ICT®: Any final words of advice?

Gossman: Well, I think it’s just important that we always do what’s best for our patients. I tell people, I put tubes in veins, that’s what I do for a living. Anytime you break the skin and you place a tube into the bloodstream, that’s a huge risk for infection. And if we work together to prevent that, and we’re all on the same page and a part of the same team, then we can do what’s best for our patients.

\This interview has been edited for clarity and length.