Peripheral Intravascular Device (PIVAD) Care Bundle to Reduce Catheter Related MRSA Bacteremia

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Authors (including presenting author) :
Kwok WM(1), Chan WL(3), Fok WM(2 ), Lai PL(4), Chan WS(9), Mok LF(5), Ho YF(6) Ho NL(1), Chea YF(2), Chung CW(8), Chan MY (7)
Affiliation :
(1) Nursing Services Division, (2) Department of Medicine, (3) Department of Orthopaedics & Traumatology, (4) Department of Surgery, (5) Accident & Emergency Department, (6) Ambulatory Surgery Centre, (7) Department of Paediatrics & Adolescence (8) Haemodialysis Centre, (9) Infection Control Team, Tseung Kwan O Hospital
Introduction :
Intravenous access among the commonest invasive procedure in hospitals, induced significant risk for bloodstream infection (BSI). While Methicillin-Resistant Staphylococcus Aureus (MRSA), a significant cause of healthcare-associated infection, will further elevate the mortality risks through bloodstream. In 2016, the Infection Control Team of TKOH observed an alarming figure of catheter-related MRSA bacteraemia, noticed of 3-4 cases reported every 6 months for 3 consecutive half-year. With the lead by the Nursing Services Division, a multi-specialities nursing task force was formed, targeted to review the care practice, identified possible pitfalls and looked for enhancement opportunity. A new care bundle was developed after, with reference to the universal advised practice. Staff compliance with the new model of care was confirmed by a record audit, which was scheduled a year after the project implementation.
Objectives :
(1) To improve the routine care of peripheral catheters, thus to reduce the risk of catheter-related MRSA bacteremia. (2) To enhance the compliance of catheter assessment record through staff training and compliance audit.
Methodology :
(1) Reviewed the peripheral catheter care guideline and clinical practice. (2) Developed the care bundle by incorporating the universal phlebitis assessment tool - the Visual Infusion Phlebitis (VIP) Score and with reference to the recommendations from professional bodies. (3) Revised the catheter care management record. (3) Provided briefing to frontlines and piloted the updated assessment form. (4) Evaluated staff feedback and finalized the assessment record accordingly. (5) Conducted compliance check by record audit
Result & Outcome :
With the implementation of new care bundle in 2017 , zero peripheral catheter-related MRSA bacteremia was reported since July 2017 in TKOH. In addition, nursing staff compliance on catheter care was observed by a snapshot through record audit in Jan 2018. A compliance check was conducted by the task force, which including one assessment form for one site, record of the catheter setup date, location, assessment time, frequency, VIP score, related nursing actions and staff name. The overall compliance rate was satisfactory, with an average of over 90% compliance rate on the identified critical points were reported in the audit.
Senior Nursing Officer

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