Nurse-led peer audits as a driver for improved peripheral intravenous catheter care and reduced bloodstream infections.

BACKGROUND

Peripheral intravenous catheters (PIVC) are widely used in acute care and are an important source of preventable peripheral line-associated bloodstream infections (PLABSI). Evidence on sustainable, nurse-led strategies to improve PIVC care and reduce PLABSI remains limited.

AIM: To describe a longitudinal multimodal quality improvement strategy combining nurse-led peer audits and real-time digital feedback to improve PIVC care and reduce PLABSI in an acute care hospital.

METHODS

A longitudinal multimodal quality improvement strategy was conducted between June 2022 and December 2025 on adult internal medicine, surgical and geriatric wards in a Belgian acute secondary care hospital. Weekly bedside audits of PIVC care bundle elements were introduced, initially led by an infection prevention and control (IPC) nurse and later transitioned to a structured nurse-led peer audit model using a digital questionnaire. Audit data were visualised in interactive dashboards alongside surveillance data.

RESULTS

A total of 6718 PIVC audits were performed. Compliance with directly observable bedside practices improved substantially, including insertion site visibility (12.7% in 2023 to >90% in 2024 and 2025) and dressing quality. Documentation- and time-dependent processes showed more limited improvement. PLABSI incidence declined progressively from 0.81 per 10,000 patient-days in 2022 to 0.29 in 2025. Several wards achieved sustained PLABSI-free periods exceeding 90 days.

CONCLUSIONS

A nurse-led peer audit strategy supported by real-time digital feedback was associated with sustained improvement in PIVC care and reduction of PLABSI incidence. Embedded within a multimodal approach, this strategy enhanced ownership and actionable feedback. Further improvement may require targeted strategies addressing time-dependent processes.