Bundle care for Hospital Accord Infection.

Infection control team/HIC/NABH/HIC Nurse.

3. 5 types.
Central line bundle.
Decubitus ulcer Prevantion .
Surgical site infection care.
UTI care bundle.
VAP bundle

5. Bundle: Bundles are defined as a group of best
practices that individually improve care, but when
applied together result in substantially greater
improvement.

6. Five evidence-based interventions
constitute the central line bundle

7. Hand hygine
Maximal Barrier Precation.
Cholorhexidene Skin Antisepsis.
Optimal catheter site selection.
Daily review of central line necessity with
promot removel of unnecessary lines.

8. .HAND HYGIENE :
•before and after palpating catheter insertion sites
•before and after inserting, replacing, accessing, repairing,
or dressing a catheter.
•When hands obviously soiled or contamination suspected.
•Before and after invasive procedures
•Between patients
•Before donning and after removing gloves
Note: palpation of insertion site should not be performed
after application of antiseptic unless aseptic technique
maintained

9. Maximal barrier precautions:
•Wear cap, mask, sterile gown and sterile gloves
both the line inserter AND immediate assistant
•Cover patient from head to toe with sterile
drape with small opening for site of insertion.

10. Chlorhexidene skin antisepsis:
•Allow time to dry completely before
puncturing site.

11. Subclavian vein the preferred site for non-
tunnelled catheters in adults.

12. •Risk of infection increases with duration of line
•Examples of appropriate uses: receipt of TPN,
chemotherapy, extended use of antibiotics,
or haemodialysis
Empower nurses and others to “STOP THE LINE
“if any of bundle components are missing.

13. *Remove unnecessary central lines
*Skin antisepsis
*Proper insertion practices
*Lower risk insertion sites
*Hand hygiene
*Hub and access port disinfection
*Educate on central line insertion and
maintenance

15. A Pressure ulcer is damage that occurs to the
skin and underlying tissue.
Pressure ulcer caused by three main thing

16. 1,Pressure –the weight of the body pressing
down on the skin.
2,Shear-the layers of the forced to slide over one
another or over deeper tissues,for example
when you slide down, or are pulled up, a bed or
chair or when you are transferring to and from
your wheel chair.

17. 3,Friction-rubbing the skin .COMMON
PRESSURE ULCERS AREAS

18. *Consider all bed-bound persons, or those
whose ability to reposition is impaired, to be at
risk for pressure ulcers.
*Older people who are ill or have suffered an
injury, for example a broken hip.
*Assess all at-risk patients/residents at the time of
admission to health care facilities, at regular
intervals thereafter and with a change in
condition.

19. *Identify all individual risk factors (decreased
mental status, exposure to moisture, incontinence,
device related pressure, friction, shear,
immobility, inactivity, nutritional deficits) to
guide specific preventive treatments. Modify care
according to the individual factors.
* Have had pressure ulcers in the past.

20. *Have diabetes (this can affect sensation and
ability to feel pain over parts of the body).
*Are seriously ill (including all patients in an
intensive care unit).

21. *Have recently had a broken hip or undergone hip
surgery, or orthopaedic patients.
*Have peripheral vascular disease (poor
circulation in your legs or arms, caused by
narrowing of your arteries by atheroma).

22. II. Skin Care
1. Perform a head to toe skin assessment at least daily, especially checking pressure points
such as sacrum, ischium, trochanters, heels, elbows, and the back of the head.
2. Individualize bathing frequency. Use a mild cleansing agent. Avoid hot water and
excessive rubbing. Use lotion after bathing.
3. Establish a bowel and bladder program for patients with incontinence. When
incontinence cannot be controlled, cleanse skin at time of soiling, and use a topical barrier
to protect the skin. Select under pads or briefs that are absorbent and provide a quick
drying surface to the skin. Consider a pouching system or collection device to contain stool
and to protect the skin.
4. Use moisturizers for dry skin. Minimize environmental factors leading to dry skin such as
low humidity and cold air.
5. Avoid massage over bony prominences.

23. III. Nutrition
1.Identify and correct factors compromising
protein/calorie intake consistent with overall goals of
care.
2.Consider nutritional supplementation/support
fornutritionally compromised persons consistent
withoverall goals of care.
3.If appropriate offer a glass of water when turning
tokeep patient/resident hydrated.
4.Multivitamins with minerals per physician’s order.

24. IV. Mechanical Loading and Support Surfaces
1. Reposition bed-bound persons at least every two hours and chair-bound persons every hour consistent with overall goals of care.
2. Consider postural alignment, distribution of weight, balance and stability, and pressure redistribution when positioning persons in chairs or
wheelchairs.
3. Teach chair-bound persons, who are able, to shift weight every 15 minutes.
4. Use a written repositioning schedule.
5. Place at-risk persons on pressure-redistributing mattress and chair cushion surfaces.
6. Use pressure-redistributing devices in the operating room for individuals assessed to be at high risk for pressure ulcer development.
7. Use lifting devices (e.g., trapeze or bed linen) to move persons rather than drag them during transfers and position changes.
8. Use pillows or foam wedges to keep bony prominences, such as knees and ankles, from direct contact with each other. Pad skin subjected to
device related pressure and inspect regularly.
9. Use devices that eliminate pressure on the heels. For short-term use with cooperative patients, place pillows under the calf to raise the heels
off the bed.
10. Avoid positioning directly on the trochanterwhen using the side-lying position; use the 30°lateral inclined position.
11. Maintain the head of the bed at or below 30°or at the lowest degree of elevation consistent with the patient’s/resident’s medical condition.
12. Institute a rehabilitation program to maintain or improve mobility/activity status.

25. Immediatly informed through incident report
form.

27. *Avoid hair removal at the surgical site. If hair
must be removed use single patient use clippers
and not razors.
*Wash the patient or make sure that the patient
has showered (or bathed/washed if unable to
shower) on day of or day before surgery.

28. * use the right drug at right time for the right
duration of antibiotic prophylaxis:
*Right drug: prescribe antibiotic prophylaxis
according to local antimicrobial prescribing
guidelines.
*Right time: Ensure that the antibiotic is given at
induction-within 60 minutes before skin incision.
In surgery where a tourniquet is to be applied. A
15 minute period is required between the end of
antibiotic administration and tourniquet
application.

29. Right duration: single dose only, unless
otherwise indicated

30. INTRA-OP
*Use 2%chlorhexidine gluconate in 70% isopropyl
alcohol solution for skin preparation. If the patient
is sensitive or allergic use povidone-iodine
Make sure that:
*The patient body temperature maintain
above 36c during the perioperative period
(Excludes cardiac patients)

31. The patients haemoglobin saturation is
maintained above 95%, or as high as possible
if there is underlying respiratory
insufficiency.
If the patient is diabetic, that the glucose level
is kept at <11 mmol/li throughout the
operation.

32. *Give an additional dose of antibiotic if the
surgical procedure is prolonged or there is
major intra-operative blood loss (>1.5 litres in
adults or 25ml/kg in children) –otherwise
the duration of surgical prophylaxis should
be a single dose.
*Cover the surgical site(wound) with a sterile
dressing prior to removal of drapes at the
end of surgery.

33. *Do not tamper with or remove the wound
dressing for 48 hours post-op unless
clinically indicated.
*Use aseptic (no touch) technique for wound
inspection and/or wound dressing changes.
*Hand hygiene is mandatory before and after
every time the wound is infected or the
dressing is changed.

34. *With the exception of a very small number of
surgical indication (see supporting
documentation), the duration of surgical
prophylaxis should be a SINGLE dose.
*Allow skin to dry thoroughly, avoid pooling of
disinfectant and drape patient after skin is dry.

35. A supplementary intraoperativeantibiotic dose
may be warranted in two circumstances: a. Blood
loss: fluid replacement-serum antibiotic
concentrations are reduced by blood loss and
fluid replacement, especially

36. A. During the first hour of surgery when
antibiotic levels are high. In the event of major
intra operative blood loss (>1.5 litres)
additional dose of prophylactic antibiotic
should be considered after fluid replacement.

37. B. prolonged surgical procedures: many
antibiotics, such as cephalosporins like
cefuroxime, are short acting and therefore an
additional dose should be administered
during the surgery if the procedure lasts longer
than 4 hours. The re-dosing time will vary
depending upon the half-life of the drug in
question. And the patients underlying renal
and hepatic function.

38. Aseptic (no touch) technique aims to prevent
microorganisms on hands, surfaces or equipment
being introduced to a surgical site (wound). Use
no touch techniques with clean or sterile gloves,
where appropriate, for any change or removal of
surgical site (wound) dressings.

39. AIM To reduce the incidence of urinary
catheter -associated infection remove catheter as
soon as possible care for catheter individualy

40. 1.Identifi signs and symptoms of UTI during
admission. if, present collect urine; obtain
physician order for UA/Culture if indicated.
2.criteria based foley insertion.
hemodynamic: critically ill or post-op patients who
need urine output measured accurately
obstruction: anatomic or physiologic outlet
obstruction retention: surgical, postpartum
neurological: debilitated, paralyzed, or
comatose patients to prevent skin breakdown and
infection

41. Hand hygiene and aseptic insertion, maintenance technique, patient
pericleaning each shift.
Maintain the urine drainage bag below the bladder, off the floor and no
dependent loops in the tubing
Use a securing deviceto prevent movement of the catheter.
Daily review of catheter necessity and prompt removal of device. D/C
the Foley

42. Not everyone with a UTI develops recognizable signs and
symptoms, but most people have some. These can
include:

43. .A strong, persistent urge to
urinate
.A burning sensation when
urinating
Passing frequent, small
amounts of urine
•Blood in the urine
(hematuria) or cloudy, strong-
smelling urine
•Fever >38deg C/100.4 deg F.Hypothermia <37deg
C/98.6deg F
•In the elderly, mental changes
can signal UTI
•Lethargy
•Pyuria+dipstick for
leukocyteesterase
and/ornitrate
b. Urine ≥ 10 WBC/mm3

44. *Review voiding practices of patients who
require assistance. Be sure patients who can
ambulate are not placed on bedpans or have
“Convenience Foleys”.
*The use of a bedside commode may be
appropriate for patients who are not able to
ambulate more than a few feet.

45. *Any abnormality of the urinary tract that
obstructs the flow of urine contributes to infection.
Any disorder of the immune system will increase
infection risk.
*Invasive examinations of the urinary tract or
contiguous areas may traumatize the urethra,
leading to irritation and subsequent infection.

46. *Clean peri area each shift with mild soap and
water.
*The most common route for organisms is by
ascent from the urethra.

47. *Prepping for midstream-voided specimens
should be done using aseptic technique. The staff
may need to review methods for obtaining this
type of specimen. If the patients are obtaining
their own specimens, they may require additional
instruction.
*Foley catheters should not be used for bladder control.
Indwelling catheters should be removedas soon as the patient's
clinical condition no longer requires precise output
measurement.
Ask every day: “Can I D/C this Foley today?”

48. Candidaspp. in the urine is for the most part a benign process
associated with the use of urinary catheters and antimicrobial
therapy.
*Staff on the unit should review all practices related to the
management of urinary catheters.

49. Ventilator Bundle:
The power of a “bundle” is that it brings together those scientifically
grounded concepts that are both necessary and sufficient to improve
the clinical outcome of interest. The focus of measurement is the
completion of the entire bundle as a single intervention, rather than
completion of its individual components.

50. *Maintaining optimal nurse-patient and respiratory
therapist -patient ratios in the ICU may favorably
influence duration of ICU stay and VAP incidence.
*A care bundle identifies a set of key interventions from
evidence –based guidelines that, when implemented, are
expected to improve patient outcomes.

51. *A landmark study demonstrated a 44.5% reduction in ventilator-
associated pneumonia using bundle approach.
*A care bundle identifies a set of key interventions from evidence
–based guidelines that, when implemented, are expected to
improve patient outcomes.

52. *Proper Hand washing
*Oral intubation, avoiding unnecessary re-intubation
*Nutritional support with enteral feeding while avoiding
gastric over distension
*Semierect positioning(300to 450)
*Use of sucralfate for gastrointestinal bleeding prophylaxis
*Venous thromboembolism prophylaxis

53. *Scheduled drainage of condensate from ventilator circuits
*Continues subglottic suctioning and maintaining adequate
endotracheal –tube cuff pressure
*Avoidance of unnecessary antibiotics and using antibiotic –
class rotation
*Chlorhexidine oral rinse
*Weaning strategies and sedation holiday
*Daily assessment of readiness to wean,use of weaning
protocols, and appropriate use of non-invasive ventilation are
associated with shorter duration of mechanical ventilation.

54. *Ventilator circuit and respiratory equipment disinfection
*Infection control and surveillance
*It is safe and justified not to change ventilator circuits unless
they are visibly soiled. Circuit should also be changed
between patients.