Infection Control Care Bundles.ppt-Grace

An overview of various ICU Care Bundles used in an NABH Accredited Hospital.
Easily understood by the nurses and other healthcare professionals.
Prevention of HAIs & Promotion of Patient safety , by strictly adhering to the CARE Bundles & the policies followed on behalf of those.

1. INFECTION CONTROL CARE BUNDLES By, Ms. Grace Angelina. A Nursing Tutor/ clinical Instructor.

2. Pre -test

3. What are Infection Control Care Bundles ? A care bundle is a collection of interventions ( usually 3 to 5), that are evidence based. All clinical Staff are aware , that, these practices are best and effective, but their application in everyday routine is inconsistent. A care bundle is the means to ensure that, application of all the interventions, is consistent for all the patients, irrespective of any specific disease conditions, at all times , thereby improving desirable outcomes.

4. Infection Control Care Bundles VAP-Ventilator Associated Pneumonia CLABSI – Central Line Associated Blood Stream Infection CAUTI – Catheter Associated Urinary Tract Infection SSI – Surgical Site Infection Sepsis Scoring

5. Ventilator Associated Pneumonia   Life threatening  complications, associated in up to 50% of ventilated patients Mortality rate 2-3 times more Definition:                   Pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation.       

6. Clinical criteria for suspicion New or  persistent infiltrate on CXR Purulent endotracheal secretions Increasing oxygen requirements Core temperature >38 degree celsius TWC  < 4.5 or   > 11.0 (in thousands)   DIAGNOSIS Endotracheal aspirate Diagnostic bronchoscopy

7. VAP – Ventilator Associated Pneumonia VAP PREVENTION BUNDLE Use of Non-Invasive ventilator  whenever possible Oral tubes are preferred Head end elevation 30-40degree Mouth care with Breast milk in NICU. Oral decontamination with 0.2% chlorhexidine thrice daily. Daily interruption of sedation  and check readiness  to  wean. Use of HME for humidification. ET tube  with subglottic suctioning  for patients more than 48 hours of ventilation. Maintenance of ET cuff pressure at least 25-30 cm of H2O and  to monitor cuff pressure Q12H.

8. Cont …. Removal of condensation from circuit and keep the  circuit closed during  condensate removal. Change the circuit only when needed (visibly soiled or  malfunctioning) Use of stress ulcer prophylaxis . DVT Prophylaxis( Flowtron Machine) Active surveillance for VAP . PVAP –Possible or Probably Ventilator Associated Pneumonia.                       Bench mark 7.5

9. CLABSI – Central Line Associated Blood Stream Infection   Central lines are used commonly in ICU’s and non-ICU populations such as dialysis units, intraoperatively, and oncology patients. Most hospital-acquired bloodstream infections are associated with a central line(including PICCs) and CLABSIs  are responsible for excess mortality, morbidity, prolonged hospital stays, and increased cost.

10. CLABSI – Central Line Associated Blood Stream Infection Hand Hygiene , maximal barrier precautions upon Insertion. Chlorhexidine skin asepsis Optimal Site selection with subclavian vein or preferred site for non- tunneled catheter. Daily review of line necessity with prompt removal of unnecessary lines. Hub – Decontamination .(8 to 10 times of rotation with sterile alcohol swab) Clean the port every time of giving injection.

11. CLABSI PREVENTION BUNDLE Education, training on insertion , care  and maintenance of CVC Use maximal sterile barrier technique  during insertion. Use alcoholic 2%chlorhexidine for skin preparation. Allow adequate time for drying of antiseptic solution before making skin puncture. Subclavian site is preferred over  jugular  and femoral. Use ultrasound  guided internal jugular  vein  catheterization . Avoid femoral lines. Appropriate  hand hygiene  during maintenance of the catheter.

12. Cont … Gauze dressing to be changed every 48 hours and tra nsparent   dressing  to be changed once in 7days. Damp ,loose or soiled dr essing to be changed immediately. Change of administration set:         routine IV set to be changed once in 72 hours.  TPN / propofol administration set to be changed once in  12 hours Blood administration set to be changed once in 12 hours or every 2 units. Needleless  connectors  are preferable over  three  way connectors. Disinfection of the catheter hub, needleless connectors  and injection port (at least 5 sec) before  accessing the catheter. Unnecessary catheter to be removed at the earliest.                                             Bench mark 2.5

13. Barrier Precautions – Dont ‘s – Partial body cover

14. Barrier Precaution – Do’s – Full body cover

15. Central Line Catheter Care Errors Factors Predisposing to CLABSI

16. IV Catheter care: is it correct ?

17. CAUTI CAUTI  is  defined as urinary tract infection in a patient  with current urinary catheterization  or who has  been catheterized in past 48 hours. It is the most common healthcare  associated  infection worldwide, resulting in increased cost, hospital stay, and substantial morbidity.             There are number of strategies with varying levels of evidence to prevent CAUTI before and after placement of urinary catheters.

18. CAUTI PREVENTION BUNDLE Education , training on insertion, care, maintenance and alternative to indwelling catheter. Insertion of urinary catheter  only  when needed and remove  them  when  unnecessary. Sterile technique during  insertion (Including  single use pocket  of sterile lubricant) Use as small a catheter  as possible  consistent  with proper  drainage, to minimize urethral  trauma.

19. Hand hygiene before insertion and manipulation of  the catheter. Ensure   proper placement of catheter at the anterior thigh to avoid contamination with faeces . Maintain continuously closed and dependent drainage (collection bag below the level of bladder ). Prescribe Silicon Catheterization for prolonged catheterization. Keep catheter and collecting tube free from kinking. To empty the collecting bag regularly before transportation and positioning to avoid retrograde flow .                                                Bench mark 4.5

20. Errors Errors – Wrongly Placed Urinary Bag & wrong Catheter Placement

21. SSI PREVENTION BUNDLE Hair removal should be done by clippers. Shaving  should be avoided. Pre surgery  whole body wash with 4%chlorhexidine solution (night before and morning of surgery )should  be done. Antibiotic prophylaxis  should  be given ( within 30-60 minutes) before skin incision ( preferably  given at induction).During prolonged surgeries re-dosing  of antibiotics should  be done if duration  exceeds  to half -lives of drug. Intra-operative temperature  monitoring  should  be done. Care should  be taken that the temperature  dose not drop below 35.5*Celsius.

22. Cont … Blood glucose should be strictly  maintained  <200mg/dl . Peri -operatively in diabetic  and  non diabetic  patients. When the surgery is being done, movement of personnel  in and out of  the theatre  should  be avoided as  far  as possible. It is preferable  to lock  the theatre  during  high risk surgeries . Follow CATS – Clippers ,Antibiotics , Temperature and Sugar Control.

23. SEPSIS SCORING Sepsis screening tools are designed to promote early identification of sepsis and consist of manual methods or  automated use of electronic health record (EHR).          There is wide variation in diagnostic  accuracy of these tools with most having  poor predictive values, although the use of some was associated with improvements in care processes.  A variety of clinical variables  and tools are used for sepsis screening such as ,                            1.  SIRS Criteria                            2.qSOFA or  SOFA                             3.MEWS 4.NEWS

24. SIRS (Systemic Inflammatory Response  Syndrome )  

25. MEWS (Modified Early Warning Score)

26. MEWS SCORE -Interventions COLOR CODE MEWS  SCORE FOLLOW UP/ NEW MEASUREMENT Blue 24 hours Yellow 1 8-12 hours Orange 2 4-8 hours Red 3-4 1-4 hours   >4 Contact physician

27. Quick SOFA Score, Does not define sepsis , But the presence of two qSOFA criteria is a predictor of both increased mortality and ICU stays of more than three days in non-ICU patients. Does not require lab tests Can be assessed quickly and repeatedly.  Question 2021  Recommendation Recommendation strength and Quality Change from 2016 In acutely ill patients should we use qSOFA criteria to screen for the presence of  sepsis? We recommend agaist using qSOFA compared with SIRS,NEWS,MEWS as a single screening tool for sepsis or septic shock. Strong , moderate- quality evidence. New recommendation.

28. Sequential (sepsis-related)Organ Failure Assessment (SOFA ) It was initially  designed to sequentially  assess the severity of organ dysfunction in patient  who  were critically ill from sepsis. SOFA uses simple measurements of major  organ function to calculate a severity score. The scores  are calculated  24 hours  after  admission  to the ICU and every 48 hours  thereafter (thus , the term “Sequential” Organ  Failure  Assessment). The highest scores are most predictive of mortality.

29. SOFA SCORING The SOFA score does not diagnose sepsis, identify those  with organ dysfunction. The SOFA score helps identify patients, who potentially have a high risk of death from infection. Maximum SOFA Score Mortality 0 to 6 <10% 7 to 9 15-20% 10-12 40-50% 13 to 14 50-60% 15 >80% 15-24 >90%

30. APACHE II  (“Acute Physiology and Chronic Health Evaluation II’’) Is a severity of disease classification system, one of several  ICU scoring systems. It is applied within 24 hours of admission of a patient to intensive care unit.    An integer score from 0 to 71 is computed based on several measurements ; higher scores correspond to more severe disease and higher risk of death. 

31. APACHE II Score is sum of;  Acute physiology score Age Chronic health score      

32. Questions Session & Post Test