Introduction • Almost 80% of patients have a peripheral intravenous catheter (PIVC) when hospitalized, as a result, septic phlebitis is one of the most severe complications 1 • A 2014 unpublished pilot study at Patan Hospital (PH) in Kathmandu, Nepal recorded the rate of septic phlebitis at 4%, almost four times the 0.5% recorded rate in a Western setting 2,3 • Hospital-based educational interventions demonstrate effectiveness in reducing PIVC associated bloodstream infections 4,5 Study Aims • Conduct quality improvement study to improve care at PH • Establish present PH septic phlebitis baseline • Implement intervention to reduce rate of phlebitis Methods PHASE 1 • Observe all PIVC sites in medical, geriatric, and step-down wards at PH every day from July 2 to July 16, 2017 • Use nursing VIP phlebitis scale to evaluate each PIVC line for signs of phlebitis in addition to custom phlebitis sign scale • Collect additional data via patient hospital charts (i.e. admission date, diagnosis, temperature (if VIP > 3), etc.) PHASE 2 Implement ”Plan” of “plan, do, study, act cycle” (PDSA) via presenting data to PH head nurse and developing literature informed serial intervention PHASE 3 Conduct “do, study, act” phases of PDSA cycle through intervention, post-interventional data collection + analysis, and repeat PDSA cycle. Peripheral IV Septic Phlebitis Quality Improvement Project in Patan Hospital, Nepal Andrew Stein 1 ∙ William Shi 1 ∙ Prashant Raj Bhatt, MBBS 2 ∙ Ujjawal Paudel, MBBS 2 Theodore MacKinney, MD, MPH, FACP 1 ∙ Darlene House, MD 2 ∙ Gyan Kayastha, MD, MPH 2 Medical College of Wisconsin 1 , Patan Hospital 2 Discussion • Phase 1 data collection revealed a decrease in septic phlebitis since the 2015 pilot study • Data represents only current PIVC data in Nepal • The rate of general phlebitis (16.44%) is higher than the 5% standard outlined by the Intravenous Nursing Society 6 • Phase 2 consisted of distributing an interventional flyer outlining phase 1 findings and IV insertion technique to the participating wards along with addressing all queries from nurses in each department • Post-interventional data has been collected for phase 3 and is currently being analyzed Next Steps • Statistically analyze post-interventional data • Determine effectiveness of intervention based on final data collection Acknowledgements Dr. Elaine Kohler Summer Academy of Global Health Research and the Medical College of Wisconsin Office of Global Health References 1. Zingg, W. and Pittet, D. (2009). Peripheral venous catheters: an under-evaluated problem.International Journal of Antimicrobial Agents, 34, pp.S38-S42. 2. MacKinney, T. (2014). Septic phlebitis rates at Patan Hospital, Nepal. Unpublished. 3. Maki DG,Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71. 4. Coopersmith CM, Rebmann TL, Zack JE, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002; 30:59–64. 5. Warren DK, Zack JE, Cox MJ, Cohen MM, Fraser VJ. An educational intervention to prevent catheter-associated bloodstream infections in a non-teaching community medical center. Crit Care Med 2003; 31:1959–63. 6. Ray-barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment measures: a systematic review. J Eval Clin Pract. 2014;20(2):191-202. RESULTS Observed PIVC VIP Scores Score Stage of Phlebitis n 0 No signs of phlebitis 221 1 Early signs of phlebitis 91 2 Early stage of phlebitis 40 3 Medium stage of phlebitis 21 4 Advanced phlebitis/thrombophlebitis 0 5 Advanced stage of thrombophlebitis 0 Observed PIVC General Statistics Total patients 93 Total PIVC lines 372 Dated 252 68% No date 120 32% PIVC Dwell Time median(dated PIVC only) 1.5 days 0-3 days 229 4-6 days 22 PIVCs indicating resiting (VIP>2) 61 Indicated PIVCs resited within 24 hours 53 87% Image 1. Nursing VIP Phlebitis Scale