BUNDLE CARE APPROACH IN MICROBIOLOGY.pptx

Dr.P.B.PRAVEENKUMAR
FIRST YEAR POSTGRADUATE
DEPARTMENT OF MICROBIOLOGY
THANJAVUR MEDICAL COLLEGE
THANJAVUR

1. BUNDLE CARE APPROACH Dr. P.B.PRAVEENKUMAR FIRST YEAR MICROBIOLOGY PG RESIDENT GOVERNMENT THANJAVUR MEDICAL COLLEGE WORLD ANTIBIOTIC AWARNESS WEEK(WAAW) - 2022

2. INTRODUCTION What is meant by care bundles? * Care bundle comprises of three to five evidence based elements with strong clinician agreement. * Each of the component must be followed by the caregiver during the insertion or maintenance of the device. * Significantly reduce mortality and morbidity .

3. CARE BUNDLE FORMS These forms are designed which comprise of various components of care bundle pertaining to CAUTI, CLABSI, VAP & SSI. Should be filled by infection control nurse not by treating team.

4. COMPLIANCE OF CARE BUNDLE Calculated by ‘All or none approach’ Failure of compliance to one component leads to noncompliance to whole bundle. It is the ratio of Number of patients on device where the all components of care bundle are followed to Total number of patients on device is multiplied by 100 .

5. CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTI) Insertion bundle Maintenance bundle

6. CAUTI (Insertion bundle) Catheter should be inserted only when appropriate indication is present. Only the sterile items are used. Inserted by nontouch technique with strict aseptic conditions. Continuous closed drainage system must be used. Catheter of appropriate size must be used. Properly secured by plaster-tube plaster technique.

7. CAUTI (Maintenance bundle) Daily catheter care ( meatal care ) by strict aseptic measures (Hand hygiene and single use gloves) Properly secured all the time Drainage bag always above the floor and below the bladder level. Closed drainage system should be used all the time. Change of gloves between the patients and separate jugs for each urine bag. Alcohol swabs for outlet and Daily assessment for readiness of removal of catheter .

8. CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI) Insertion bundle Maintenance bundle

9. CLABSI (Insertion bundle) Hand hygiene prior to insertion of central line. Use maximum sterile barrier precaution like gloves, gown, drapes, cap and mask. Subclavian is preferred and better to avoid femoral. Skin preparation – Chlorhexidine (CHG) is preferred ; If age is less than two months we can use Povidone iodine (Allergy to CHG) Skin is completely dry after the use of antiseptics. Use semipermeable dressing and handwash after this procedure Document date and time of insertion .

10. CLABSI (Maintenance bundle) Daily aseptic central line care like hand hygiene and alcohol rub decontamination . Daily documentation of local sign of infection . Change of dressing with 0.5% chlorhexidine . Daily assessment of readiness of removal of central line must be documented.

11. VENTILATOR CARE BUNDLE Adherence to hand hygiene Elevation of the head of the bed to 30 to 45 degrees. Daily oral care with 2% chlorhexidine solution Need of Peptic ulcer disease prophylaxis to be assessed and even if needed sucralfate alone should be used. DVT prophylaxis should be given if needed. Daily assessment of readiness to remove mechanical ventilator must be documented.

12. HOW THIS BUNDLE CARE FORM LOOKS LIKE?????

13. SURGICAL SITE INFECTION BUNDLE (SSI BUNDLE) THREE COMPONENTS Preoperative Perioperative Post operative

14. SSI (PREOPERATIVE) Preoperative bathing Screening for Staphylococcus aureus Hair removal not done or removed by clipper Surgical antimicrobial prophylaxis (Right choice, Right timing, Right dosage and Right frequency)

15. SSI (PERIOPERATIVE) Surgical site skin preparation (Antiseptics with alcohol) Hand scrub before and in between the cases Oxygenation of Fio2 (80%) Normothermia (36 degrees celsius ) Blood glucose (140-200 mg/dl) Normovolemia

16. SSI (POST OPERATIVE) Aseptic nontouch technique Surgical dressing Hand hygiene

17. MULTI DRUG RESISTANT ORGANISMS BUNDLE (MDRO) Evidence based precautionary measure to contain the transmission of MDRO. Review of MDRO should be done annually.

18. COMPONENTS OF MDRO BUNDLE Active surveillance Antimicrobial stewardship programs Contact precautions for patients/Health care workers infected with MDRO s Hand hygiene compliance Environmental hygiene as per institutional guidelines Antiseptic body baths for patients/HCWs to reduce bioburden .

19. MEDICAL EXAMINATION OF FOOD HANDLERS MEDICAL TEST FREQUENCY Complete physical examination Once a year Stool examination for ova, cysts and parasites Every three months Stool culture for salmonella Every three months Routine CBC Every three months CXR, Widal test and Stool culture for cholera Only if indicated

20. PERSONAL HYGIENE OF KITCHEN WORKERS Fresh washed clothes everyday Clean apron Hand hygiene (Clean and short nail) Hair cap ( No loose hairs for females & Clean shave for males ) Open wound should be covered with water proof dressing while duty NO SMOKING AND ALCOHOL Respiratory hygiene and cough etiquette

21. EDUCATION AND TRAINING OF KITCHEN WORKERS FREQUENCY : At the time of joining the job, routinely at least twice yearly and after returning from long leaves and during outbreak situations. Education on food borne hygiene , food borne illness Posters and visual signages to reemphasize personal hygiene Vaccinated against Hepatitis A, Typhoid & cholera

22. CARE OF REFRIGERATORS Temperature monitoring at least once daily (2-4 degrees celsius ) using electronic sensors or thermometer inside Away from heat sources (Clearance must be there at back for heat escape) Defrosting Over storage of food items should be avoided to have good air circulation inside Don’t store medicine or clinical items in kitchen fridge

23. CARE OF REFRIGERATORS (cont.) Routine inspection of refrigerator at least twice daily to remove food items without labelled . Labelling should be done on all covers. LABEL NAME OF THE PRODUCT DATE OF STORING BEST USE BEFORE DATE AND TIME OTHER SPECIFICATIONS, IF ANY

24. APPROVED CLEANING PROCEDURE FOR REFRIGERATORS

25. CARE OF MICROWAVE OVEN Food that is not consumed at the meal time must be disposed it off and should never be reheated. Regular cleaning should be ensured. Should be serviced regularly and monitoring for leakage.

26. CARE OF ICE MAKING MACHINES Ice may become easily colonized with food borne pathogen. Most common source of contamination : Potable water from which it is made and transfer of organisms from hands during dispension of ice.

27. PRECAUTIONS FOR CONTAMINATION OF ICE PRODUCTS Ice must never be handled with bare hands . Shovels and tongs should be stored outside the machine and be kept it dry till usage. Emptied, washed and dried at least once in a week

28. THIS IS HOW WE ARE SEEING THE BUNDLE CARE APPROACH..

29. BUT IN REALITY.......

30. THANK YOU