Implementation of evidence-based care bundles to prevent healthcare-associated infections

Vinay M N1, Gowtham2

1Infection Control Supervisor, Kauvery Hospital, Marathahalli

2Nursing educator, Kauvery Hospital, Marathahalli

Abstract

This report highlights a systematic approach to minimizing healthcare-associated infections (HAIs) through the application of evidence-based care bundles. The presentation elaborates on best practices and standardized interventions tailored for specific infection types such as ventilator-associated events (VAE), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI). Additionally, the importance of isolation precautions and the distinction between various modes of transmission are underscored to strengthen infection control measures in clinical settings.

Introduction

Healthcare-associated infections pose significant challenges in hospital environments, affecting patient outcomes, increasing morbidity, and elevating healthcare costs. Bundles—defined as structured, evidence-based interventions—are designed to improve patient safety and standardize care across diverse clinical situations.

Ventilator-Associated Events (VAE) Bundle

Definition

Ventilator-associated pneumonia (VAP), a subtype of hospital-acquired pneumonia, affects patients undergoing mechanical ventilation.

  • Proper hand hygiene and application of the “3 Gs” and “M” as applicable.
  • Daily sedation breaks and extubation readiness assessment.
  • Elevation of the head end (30–45 degrees).
  • Use of heat moisture exchangers (HMEs) and catheter mounts only when visibly soiled.
  • Prophylaxis for deep vein thrombosis and peptic ulcers.
  • Aseptic suctioning using disposable catheters.
  • Chlorhexidine oral rinse every 8 hours.
  • Closed suction systems and minimal circuit changes.
  • Peptic ulcer prophylaxis.

Central Line-Associated Bloodstream Infection (CLABSI) Bundle

  • Rigorous hand hygiene before and during central line care.
  • Full barrier precautions during catheter insertion.
  • Skin antisepsis with chlorhexidine.
  • Preferred catheter site: subclavian vein (non-tunneled).
  • Routine catheter flushing every 6 hours or every shift.
  • Transparent dressings, changed every 5–7 days or when soiled.
  • Port swabbing before medication administration and blood draws.
  • Daily review and timely removal of unnecessary lines.
  • Flushing the line before and after providing drugs.

Catheter-Associated Urinary Tract Infection (CAUTI) Bundle

  • Strict hand washing.
  • Sterile technique during catheter insertion with single-use lubricant.
  • Avoidance of catheter loops.
  • Regular drainage of the urinary bag, maintained below waist level.
  • Thrice-daily Foley catheter care using soap and water.

Surgical Site Infection (SSI) Bundle

Pre-operative Measures

  • Hair removal using surgical clippers; razors discouraged.
  • Administration of prophylactic antibiotics 30 minutes to 1 hour before incision.
  • Maintenance of normothermia (non-cardiac patients) and euglycemia (non-diabetic patients).

CATS protocol: Clippers, Antibiotics, Temperature, and Sugar control.

Intra-operative Measures

  • Sterile surgical technique.
  • Controlled operating theatre traffic and minimized door movement.

Post-operative Measures

  • Sterile wound dressing and appropriate drain management.
  • Isolation and Transmission-Based Precautions

Overview

Isolation precautions are critical to limiting the spread of contagious pathogens. They combine standard precautions with additional transmission-based protocols.

Types of Precautions

Standard: Applicable to all patients; includes hand hygiene, PPE, safe injections, waste management, and linen care.

Contact: For MRSA, C. difficile; requires gloves, gowns, and private rooms.

Droplet: For influenza, meningitis; requires surgical masks within 3–6 feet.

Airborne: For TB, measles; necessitates N95 respirators and negative pressure rooms.

Conclusion

The structured implementation of care bundles offers a practical and effective strategy to reduce HAIs. By standardizing procedures and emphasizing multidisciplinary compliance, hospitals can enhance patient safety and overall care quality.

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