Welcome / Croeso 08.03.2011 Dr. Eleri Davies Insert name of presentation on Master Slide

Team Progress Baseline Data Collection Sharing Best Practice – learning from each other

Why Are We Here? Reducing Waste Reducing Harm Reducing Variation Unnecessary placement of urinary catheters and peripheral vascular cannulae Reducing Harm Infectious and other complications of the medical devices Reducing Variation Ensuring the same evidence based standard of care for all patients

Urinary Catheters Commonest HCAI in US – 32% 16% of HCAI in 2006 prevalence survey Wales were UTI. Attributable mortality as high as 13% in cases complicated by Bacteraemia. Klevens RM, Edwards JR, Richards CL Jr, et al. Estimating health care associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166 Humphreys H, Newcombe RG, Enstone J, et al. Four country healthcare associated infection prevalence survey 2006: risk factor analysis. J Hosp Infect 2008;69(3):249–257.

Peripheral Vascular Cannulae IVDs (all) are single most important cause of HA-BSI – US 0.5 blood stream infections per 1000 catheter days Health Board data (Wales) 2010 41% of patients had Peripheral cannulae in situ 1.6% infected Mayo Clin Proc. • September 2006;81(9):1159-1171

Urinary Catheter Care Bundles Step 1 Organising a team Identifying pilot sites (3 areas) November 2010 Step 2 Baseline Data Agree care bundle for local use Goal - December 2010 Step 3 Testing of care bundle in pilot sites Implementation in pilot sites Goal - February 2011 Step 4 Demonstrate reliable implementation Spread beyond pilot sites Goal - August 2011 ongoing Urinary Catheter Care Bundles

Peripheral Vascular Cannula Care Bundles Step 1 Organising a team Identifying pilot sites (3 areas) Goal - January 2011 Goal - March 2011 (LS3) Step 2 Baseline Data Agree care bundle for local use Step 3 Testing of care bundle in pilot sites Implementation in pilot sites Goal - October 2011 Goal - June 2012 ongoing Step 4 Demonstrate reliable implementation Spread beyond pilot sites Peripheral Vascular Cannula Care Bundles

Baseline Data Without baseline data how can you demonstrate improvement?

Baseline Data (UC) (minimum requirement) Numbers of urinary catheters being placed

Baseline Data (UC) Number of avoidable catheterisations List of indications Audit process retrospectively Collect prospectively as catheters are placed

Baseline Data (UC) Numbers of Catheter Associated Urinary Tract Infections (CAUTI) Use definitions provided Assessment of numbers of secondary blood stream infections (UC) Unit / hospital/organisational Seek advice from local microbiology departments

Baseline Data (PVC) (minimum requirement) Number of PVCs being placed Establish a system for monitoring the PVCs and assessing them using the Visual Infusion Phlebitis Score (VIP): Document numbers of PVCs with a VIP score of ≥2

Baseline Data (PVC) How many per day require removal / replacement on the basis of their VIP (removed appropriately - Y/N)

Baseline Data (PVC) NHS Tayside (Safer Patient Network): MRSA/MSSA infections Hand hygiene compliance Consider monitoring 20 Blood Stream Infections related to PVCs MRSA / MSSA, but also other organisms Most useful at Unit / Hospital / Organisation level.

For Discussion Today How are your teams developing Baseline data – what is it telling you? Care Bundle piloting – any issues General feedback on implementation plans.