UK Vessel Health and Preservation Framework 2020: a users' survey.

The review and update of the UK Vessel Health and Preservation Framework 2020 (VHP2020) was undertaken by a working group that included members of the Infection Prevention Society, the Royal College of Nursing, the National Infusion and Vascular Access Society and the Medusa Advisory Board and was launched in 2020. The VHP working group developed a survey to understand whether the VHP2020 had reached its intended audience, and what respondents thought were the benefits and drawbacks of its use in practice. Although the survey response was lower than expected, the responses received were largely positive and have provided feedback on how the VHP2020 is being used and some of the benefits. Most importantly, the survey has highlighted the need to communicate the benefits of the framework more effectively to reach a wider audience.

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020.

BACKGROUND: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. DEVELOPMENT OF THE VHP 2020 FRAMEWORK: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. FINDINGS: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the 'A-DIVA scale' to predict the likelihood of difficult venous access; and a study that incorporated an 'I-DECIDED tool' for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. CONCLUSION: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

International recommendations for a vascular access minimum dataset: a Delphi consensus-building study.

BACKGROUND: Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset. METHODS: A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices. RESULTS: A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes. CONCLUSION: We developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.

COVID-19: considerations for the safe management and disposal of human excreta.

Management and disposal of human excreta is an essential element of healthcare practice. The potential for cross transmission of SARS-CoV-2 in faeces and urine has led global healthcare providers to examine different infection prevention and control practices not least the management and disposal of human excreta. There are two major systems in place to undertake this; one being the use of re-usable bedpans and urinals with reprocessing in a washer disinfectors (WD). The other is use of disposable system; either with pulp bedpans and urinals disposed of in a macerator or hygienic bags disposed of as waste. A review of the literature provided limited evidence to explore these different methods; both having pros and cons with regards to the environmental aspects as well as the infection prevention and control implications. Manual cleaning can pose associated infection risks to both staff and patients. Disinfection of re-usable bedpans may not achieve the level of disinfection required. Disposable systems offer an alternative that can overcome some of the infection prevention and control limitations of washer disinfectors. Adherence to infection prevention and control standards are paramount to the safe management and disposal of excreta.

Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation.

BACKGROUND: Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. METHODS: Using the Outcome Logic Model, we conducted an evaluation of the short- and medium-term outcomes with regards to the impact and success of the VHP Framework. RESULTS: This evaluation found that many respondents were aware of the framework and were using it in a range of different ways. Participants saw the framework as being most beneficial to help decisions on device choice and peripheral vein assessment. However, the framework has not fully reached its intended audience. DISCUSSION: Many positive outcomes were reported as a result of using the VHP Framework including improving clinical practice as it relates to the VHP elements. However, further work is required to find the tools to extend the reach of the framework and assist healthcare teams to be able to fully implement it within their clinical settings.

Establishing catheter-related bloodstream infection surveillance to drive improvement.

BACKGROUND: Catheter-related blood stream infections (CRBSI) are an important complication of central venous access devices but are often poorly measured. This article describes the journey of one hospital trust to set up a surveillance process for CRBSI across all specialties of the trust and to reduce CRBSI. METHOD: Using a locally adapted CRBSI criteria and root cause analysis (RCA) for investigation we identified a number of opportunities for a quality improvement programme. FINDINGS: Over a 5-year period we saw a significant and sustained reduction in the rate of CRBSI from 5 per 1000 catheter days to 0.23 per 1000 catheter days. CONCLUSIONS: The surveillance enabled rates of CRBSI to be monitored across the trust and the success of our improvements to be measured.

Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative.

Vascular access is an important part of many patient care management plans but has some unwanted risks. Previous work published by Moureau et al. (2012) inspired a working group led by the UK Infection Prevention Society (IPS) to produce a vessel health and preservation (VHP) framework. This was with the intention of producing a resource for frontline staff to be able to assess and select the best vascular access device to meet the individual patient's needs and to preserve veins for future use. The working group produced a framework that used available evidence, expert opinion and some small scale testing of the components of the framework. The work so far has received positive feedback but further work is required to formally evaluate the VHP framework in clinical practice to measure both staff knowledge and patient outcomes.

Antimicrobial stewardship: the role of the nurse.

Infections caused by organisms resistant to multiple drugs are associated with morbidity and mortality, prolonged hospital stay and increased costs. Since antibiotic use is the main factor in the development of resistance, it is hoped that the judicious use of antibiotics will reduce the emergence of antimicrobial resistance. This article addresses antibiotic misuse in the inpatient setting and outlines the role of the nurse in optimising antibiotic therapy through antimicrobial stewardship.

Right line, right patient, right time: every choice matters.

The field of vascular access has developed significantly over recent decades. It has been adapted to provide a range of techniques for a range of patients much faster than a full appreciation of the risks involved has developed. Improved governance of vascular access procedures in the UK is needed. This is driven by a deeper understanding of risks such as infectious and thrombotic complications, repeated failures of peripheral intravenous (IV) access leading to poor patient experience and treatment inadequacy, and the increasing emphasis on avoiding healthcare-associated infections. The Vessel Health and Preservation (VHP) protocol, which is used to standardise vascular access practice in the US is being evaluated for adoption in the UK. A comprehensive and inclusive approach should be taken to the vascular access needs of all patients.