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 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
 5 Interventions
Check if PVC in situ
– Ask patient or check for PVC
– If no
– Decontaminate hands and move to next patient
PVC in PVC No Dressing PVC Hand
situ in Inflammation/ intact < 72 hygiene
Use Extra-vasiation hrs

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

Yes Yes

PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand

situ Use Extra-vasiation intact hygiene

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

Yes Yes Yes

PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand

situ Use Extra-vasiation intact hygiene

Yes Yes No - - -
Remove PVC
 3. PVC dressing intact

Pictures with permission from IV team Rotherham Trust

 3. Dressing Intact
PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand
situ Use Extra-vasiation intact hygiene

Yes Yes Yes yes

PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand

situ Use Extra-vasiation intact 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 hours
PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand
situ Use Extra-vasiation intact or as per hygiene
local
decision

Yes Yes Yes yes yes

PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand

situ Use Extra-vasiation intact 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 PVC in No Inflammation/ Dressing PVC < 72 hrs Hand
situ Use Extra-vasiation intact or as per hygiene
local
decision

Yes Yes Yes yes yes yes

PVC in PVC in No Inflammation/ Dressing PVC < 72 hrs Hand

situ Use Extra-vasiation intact hygiene

Yes Yes Yes Yes No – remove no

catheter
 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