Implementation of Care Bundles at ward level

Content• Why implement the PVC care bundle?

• Implementation

• Monitoring Implementation

Why?• Implementing guidelines – All acute hospitals have guidelines on PVC

management and care– Allows wards/units to demonstrate that PVC care

is their ward is best practice- ensures that these guidelines are implemented in

all wards consistently or if necessary targets education to those areas with greatest need

Why?• Rate of bacteraemia associated with PVC is

increasing year on year • HIQA Infection Control Standards 2008

Standard 8 Device related infections are reduced or prevented• Criteria 8.1

“the implementation of a structured set of processes that have been proven to improve outcomes, (e.g. bundles) for the prevention of invasive medical devices related infections”

Implementation• Each site should decide how best to approach

local implementationFactors to take into account

• Target consultants/ward managers in a small number of wards initially

• Weekly care bundle - Medical and nursing staff should complete bundle together (e.g. at ward rounds)

• Agree that IPCT are informed when on going non compliance is identified

• Use of excel document to tract results & avoid paper work

5 Interventions Check if PVC in situ – Ask patient or check for PVC – If no – Decontaminate hands and move to next patient

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs

Hand hygiene

No - - - - -

PVC in situ

2. Is PVC in use? • Current IV therapy (medication or infusion) ?• PVC required for planned clinical procedure

(radiology, transfusion etc)• Vascular access required due to unstable conditionPVC in situ and in use select “yes” & go to question 3If PVC in situ but not in use and not required, remove

PVC and select “no” to this question Decontaminate hands and move to next patient

PVC in situPVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes NoRemove PVC

- - - -

2. Absence of inflammation/extra-vasiation

Sample phlebitis scale

Absence of inflammation/extra-vasiation

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes Yes

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes NoRemove PVC

- - -

3. PVC dressing intact

Pictures with permission from IV team Rotherham Trust

3. Dressing IntactPVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes Yes yes

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes Yes No – replace dressing or remove PVC

- -

4. PVC in place < 72hours

• Not applicable in paediatrics• 72 hours is not an absolute cut off – local

clinical decision based on expected duration of PVC, condition of PVC entry site, vascular access

• > duration of PVC > greater risk of infection• Determining exact date of insertion from

medical notes/nursing notes

4. PVC in situ < 72 hoursPVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs or as per local decision

Hand hygiene

Yes Yes Yes yes yes

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes Yes Yes No – remove catheter

-

5. Hand Hygiene

• Hand hygiene before and after contact with PVC

• Observe HCWs during administrating of IV medication/adjusting infusions during nursing shift that hand hygiene occured

5. Hand Hygiene PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs or as per local decision

Hand hygiene

Yes Yes Yes yes yes yes

PVC in situ

PVC in Use

No Inflammation/Extra-vasiation

Dressing intact

PVC < 72 hrs Hand hygiene

Yes Yes Yes Yes No – remove catheter

no

Results • Target 100% for all PVC’s in all patients• All 5 elements must be Yes to score• Example 10 PVC’s in situ – 5 = 5 yes answers – 3 = 4 yes answers – 2 = 3 yes answers

• 50% compliance is the ward score

Implementation monitoring • CEO/senior area manager will report to LIT the

% of wards in each site using PVC care Bundle from January 2010

• January 2010 – report all bacteraemia associated with PVC to risk management

• HPSC monitoring national data using enhanced bacteraemia from participant laboratories