Authors (including presenting author) :
Ng MT(1), Leung FY(1), Fung YL(1), Lau KF (1), Ng PY(1)
Affiliation :
(1) Infection Control Team, Caritas Medical Centre
Introduction :
In view of high prevalence of MRSA bacteremia related to PVC phlebitis in CMC since 2015, an improvement program of PVC care was introduced in CMC at the early of 2018. To begin with, pilot implementations were conducted in orthopedic and surgical wards with satisfactory outcome by July of 2018. Therefore, the program was promulgated to all wards in CMC by the end of 2018. Fruitful result was achieved with the MRSA bacteremia rate dropped over 50% by June of 2019 in CMC. Strategies for sustaining the good PVC care practice in CMC are to conduct regular audits and to provide concurrent feedback by infection control nurses (ICNs).
Objectives :
1. To enhance nurse knowledge on PVC care including early detection of phlebitis and bundle of care of PVC
2. To sustain the bundle of care of PVC in CMC by regular audits and concurrent feedback by ICNs
Methodology :
1. Bundle of PVC care was designed after literature review. Seven elements were highlighted which are: 1) hand hygiene; 2) proper aseptic technique; 3) preferable to choose upper extremity for PVC insertion; 4) skin preparation by using 2%CHG in 70% alcohol; 5) application of sterile, semi-permeable and transparent dressing; 6) daily review the necessity of PVC; 7) proper documentation including visual infusion phlebitis (VIP) score. A poster of the bundle of care was designed for educational purpose.
2. VIP score was introduced to CMC as the standardized assessment tool
3. Tailor made educational talks were held for nurses by departmental base
4. Three audits were conducted by ICNs together with the Quality and Safety Department
5. Two identical IC talks were held for sharing of the audit results and findings
6. Continuous audit with concurrent feedback is ongoing
Result & Outcome :
With the successful outcome of pilot implementations of PVC care improvement program in orthopedic and surgical wards, the program was introduced to whole hospital progressively in 2018. Total 221 PVC sites were recruited for audits. The audit results showed that 1) nurses were more competent to apply the bundle of care of PVC; 2) nurses were more familiar to VIP score and to apply it as a standardized assessment tool; 3) “no phlebitis (VIP =0) in patient” was improved from 63% to 100%. By June of 2019, MRSA bacteremia rate was dropped 50% in CMC which was a cheerful result for the program.
