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

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

3. 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

4. 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, 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.

6. 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) % of patients had Peripheral cannulae in situ
1.6% infected
Mayo Clin Proc. • September 2006;81(9):

8. 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

9. 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

10. Baseline Data
Without baseline data how can you demonstrate improvement?

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

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

13. 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

14. 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

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

16. 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.

18. 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.