Mr Ismail Bin Sazali1
1Singapore General Hospital, Singapore
Biography:
Ismail Bin Sazali is an Infection Prevention Nurse at SGH and a Credentialled Infection Control Professional – Expert with ACIPC. He holds a Master’s in IPC and leads quality improvement initiatives like CLEAN IV. His work spans frontline care to system-level innovation, contributing to both local and international IPC efforts.
Abstract:
Intravenous (IV) cannulation is a common but high-risk procedure in the Accident & Emergency (A&E) setting, where inadequate skin antisepsis contributes to complications such as thrombophlebitis and bloodstream infections (BSIs). At a tertiary hospital in Singapore, surveillance from June to December 2023 identified a significant number of secondary BSIs linked to IV insertions in the Department of Emergency Medicine (DEM), with thrombophlebitis as a key contributor.
To address this, the CLEAN IV quality improvement initiative was implemented with the goal of reducing phlebitis and IV-related BSI rates by 50% over 12 months. The intervention involved the introduction of chlorhexidine-based alcohol swabs and the standardisation of IV skin antisepsis protocols. Training was conducted between Weeks 29 and 31 of 2024, followed by full implementation in Week 31. Compliance audits began in Week 35. Primary outcomes included phlebitis and BSI incidence rates per 1,000 patient-days, focusing on infections caused by skin commensals such as Staphylococcus epidermidis, Cutibacterium acnes, and Micrococcus species.
Early implementation was challenged by confusion over swab availability and inconsistent staff compliance. Targeted education and reinforcement strategies led to 100% compliance by Week 36. Post-intervention data showed a reduction in phlebitis incidence from 0.52 to 0.26 (50% decrease), and BSI incidence from 0.37 to 0.18 per 1,000 patient-days (51.4% decrease).
This project demonstrates that enhancing skin antisepsis practices at IV insertion points in high-acuity settings can significantly reduce complications. Key success factors included real-time audit feedback, consistent education, and clear protocol rollout.