PLUS
September 2011 – ‘Simple is Effective’
Peripheral Vascular Cannula and Short Term Urinary Catheter
Insertion and Maintenance Bundles
Presenter: Tracey Nicholas
Hywel Dda
Local Health Board
Baseline Data
Prevalence Survey 2010 Hywel
Dda Health Board
Total Number
Hospital
Acquired
Peripheral Line
52
5
Catheter
22
2
Hywel Dda
Local Health Board
Defined Types of HAI
UTI
Blood Stream 4%
8%
Bone & Joint
8%
1.
Baseline August
2010
Systemic
inf ection
4%
Skin & Sof t
Tissue
22%
Pneumonia
12%
GI Tract
12%
SSI
15%
DEVICES/PROCEDURES
Peripheral Line
52
Catheter
22
√
Hand hygiene
Skin Prep
(Chloraprep)
PPE
Dressing
Signature ……………………..
4. Short Term Urinary Catheter Roll
out August/Septemeber 2011
√
Resp Tract
15%
2. ChloraPrep 0.67ml Sepp Implemented 2010
3. Peripheral Vascular Cannula
Insertion Bundle revised roll out
August/Sept 2011
Total Number
√
Prescription Chart sticker
Hand hygiene
PPE
Aseptic Technique
Clean urethral meatus
Sterile closed drainage system
Documentation
Signature …………………………….
OUTCOME = MRSA Bacteraemias April 2010-March 2011
√
Prescription Chart sticker
Hywel Dda
Local Health Board
Sticker Development
Peripheral Vascular Catheter Insertion Bundle
Date ..../..../.... Day 1
Hospital ............................
Time ......................
Ward ............................
Reason for Insertion (Please cross all that apply)
IV Fluids
Antibiotics
Insertion Technique
Blood Transfusion
yes
Pain
Control
ye
s
no
Hand Hygiene
Sterile Gloves
Informed Patient consent
Dressing Applied – clear,
semi-permeable dressing
Skin Preparation – 2% Chlorhexidine in
70% Alcohol
Cannula Flushed
Allow to dry for 30 secs
Number of attempts
Cannula Size
Batch No
Other (Please
state)
..............................
no
Cannula Site
Print Name ............................ Signature...................................... Designation.....................
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Peripheral Intravenous Cannula Care Plan
and Maintenance Bundle
Hywel Dda
Local Health Board
`
Short Term Urinary Catheter Care Plan and
Maintenance Bundle
Hywel Dda
Local Health Board
Roll out Programme
‘Start Small and Roll Out!’
Hywel Dda
Local Health Board
SPREAD &
SUTAINABILITY
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Compliance
• Required to fit into 1000 lives plus
requirements
• Report Locally & Nationally
• Compare practice between wards
• Fit with Nursing Metrics/Dashboard
• Be aware of where we need to
improve
• Collect data
Hywel Dda
Local Health Board
Audit Process
Compliance Audit:
• Took methodology used for Hand
Hygiene Compliance
• Developed Tool x2
• Pilot Results/Sampling 10 each ward
each month
Hywel Dda
Local Health Board
Excel Template
• Automatically Calculates compliance
• Summarises results per hospital
• Summarises Results of LHB
• Data formatted so that it is cut and
pasted into PowerPoint Template
• Example graph overleaf.
• Process takes very little time
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Hand Hygiene Compliance Rates – Staff Type
100%
100%
100%
100%
100%
95%
94%
94%
92%
87%
85%
86%
83%
78%
78%
75%
75%
71%
60%
60%
53%
NA
50%
25%
0%
0%
Manager/
Sister
Nurses
Student
Nurses
CNS/NNP/ Consultants
Bed Mngr
PPH
Senior Dr
Junior Dr
WWGH
HCA
AHP
Ancillary
Other
Hywel Dda
Local Health Board
Type of Decontamination Missed
15
14
10
8
8
7
6
5
3
0
Before Patient
Contact
Before a clean
Aseptic Proceedure
After Body Fluid
Exposure
PPH
After Pt Contact
WWGH
After Contact
Patient Immediate
Surroundings
Hywel Dda
Local Health Board
Title
9 Criteria identical to Care Bundle. Reply Yes, NO, NA
Hywel Dda
Local Health Board
Hywel Dda
Local Health Board
Excel Templates in Draft
• Currently piloting Catheter and IV
Data Collection Tools
• Automate the Audit process
• Fit for all reporting purposes
• Compare compliance rates
• Feedback Good and Bad Practice
Hywel Dda
Local Health Board
Pilot Results
• 3 Wards Audited
• Good Compliance Rates
• Excel Data Collection Tool still needs
tweaking to be as effective as Hand
Hygiene
• Has highlighted areas of the bundle
that require further input
Hywel Dda
Local Health Board
0%
75%
Access Port
Dissinfected and
Allowed to Dry
75%
Dressing Dry &
Intact
13%
75%
VIP Score Less
than 2
25%
75%
Indication for Use
50%
75%
Hand Hygeine
75%
Care Bundles
Completed
Sticker Present
Pilot Results
100%
75%
Hywel Dda
Local Health Board
Just the Tip of the Iceberg!
Part 1
Clostridium difficile
Elective Orthopaedic
SSICVL/VAP Bundles
MRSA/MSSA
Caesaran Section SSI
Breast SSI
CABSI - Peripheral Lines
Other Multi Resistant Germs:
SSI :
• Vascular
•Gynaecology
• VRE
• GRE
• MDR TB
• Urology
• ESBL s E.Coli Klebsiella
• ENT
• Acinetobcater
•Ophthalmology
• Candida
CAUTI- LDP
•Serratia
Hywel Dda
Local Health Board
Just the Tip of the Iceberg!
Part 2
Clostridium difficile
Elective Orthopaedic SSI
CVL/VAP Bundles
MRSA/MSSA
Breast SSI
Caesaran Section SSI
Peripheral Lines
CABSI SSI :
Vascular
Gynaecology
Urology
ENT
Ophthalmolog
y
CAUTI
Other Multi Resistant Germs:
• VRE
• GRE
• MDR TB
• ESBL s E.Coli Klebsiella
• Acinetobcater
• Candida
•Serratia
Hywel Dda
Local Health Board
Thankyou
Any Questions?
Hywel Dda
Local Health Board