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Background Peripheral venous catheters (PVCs) are ubiquitous in hospitals, yet phlebitis remains common despite single-measure prevention. Robust long-term evidence on whether comprehensive bundles sustainably reduce phlebitis is limited. The objective was to determine whether a five-element bundle (Flebitis Zero) reduces PVC-related phlebitis and whether increasing adherence confers incremental benefit.Methods A quasiexperimental pre-post study was conducted in 93 Spanish hospitals (2017–2024). PVCs placed in adult medical and surgical wards during 15 consecutive days each year were prospectively audited (78 691 PVCs in 53 121 patients). Daily data included bundle adherence (nine indicators) and phlebitis (Maddox score ≥2). Frequencies, relative risks (RRs) and Mantel-Haenszel χ² trend tests were calculated. A multivariable logistic regression model was employed. The dependent variable was phlebitis incidence; independent variables were bundle adherence, implementation year and inpatient unit. This model identified factors independently associated with phlebitis (p<0.05).Results Phlebitis incidence declined from 12.1% to 9.9% over 8 years (18% relative reduction). Seven of nine indicators improved by 5–15 percentage points, including sterile dressing (+9.6 percentage points), hand hygiene (+7 percentage points) and secure fixation (+5.7 percentage points). A clear dose-response emerged: implementing ≥ three measures conferred an additional 17–25% risk reduction versus ≤two measures and fulfilling the four audited actions achieved up to 77% lower risk (RR=0.23; trend χ²= 67.4; p<0.001). Multivariable analysis confirmed full adherence (four measures: aOR=0.612; p<0.001); the implementation year (year 2021: aOR=0.689; p<0.001) and the inpatient unit (surgical: aOR=0.868; p<0.001) independently lowered phlebitis risk.Conclusions Incremental adherence to the Flebitis Zero bundle sustainably decreases phlebitis. Achieving at least three measures is the minimum quality target, while full adoption offers maximal protection.