1. Implementation of Care Bundles at ward level

2. Content Why implement the PVC care bundle? Implementation
Monitoring Implementation

3. 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

4. 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”

5. Implementation
Each site should decide how best to approach local implementation
Factors 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

6. 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 -

7. 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 condition
PVC in situ and in use select “yes” & go to question 3
If 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

8. PVC in situ PVC in situ PVC in Use No Inflammation/ Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes
PVC in situ
PVC in Use
No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes No
Remove PVC -

9. 2. Absence of inflammation/ extra-vasiation
Sample phlebitis scale

10. Absence of inflammation/ extra-vasiation
PVC in situ
PVC in Use
No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes
PVC in situ
PVC in Use
No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes No
Remove PVC -

11. Pictures with permission from IV team Rotherham Trust
3. PVC dressing intact
Pictures with permission from IV team Rotherham Trust

12. 3. Dressing Intact PVC 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
No – replace dressing or remove PVC -

13. 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

14. 4. PVC in situ < 72 hours PVC in situ PVC in Use No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs or as per local decision
Hand hygiene
Yes
yes
PVC in situ
PVC in Use
No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes
No – remove catheter -

15. 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

16. 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
PVC in situ
PVC in Use
No Inflammation/
Extra-vasiation
Dressing intact
PVC < 72 hrs
Hand hygiene
Yes
No – remove catheter no

17. 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

18. 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