Examples of Evidence-Based “Bundled Interventions” to Prevent Common Health Care-Associated Infections and Other Adverse Events
| Prevention of Central Venous Catheter Infections |
Catheter insertion bundle: Educate personnel about catheter insertion and care. |
| Use chlorhexidine to prepare the insertion site. |
| Use maximal barrier precautions and asepsis during catheter insertion. |
| Consolidate insertion supplies (e.g., in an insertion kit or cart). |
| Use a checklist to enhance adherence to the “insertion bundle.” |
| Empower nurses to halt insertion if asepsis is breached. |
Catheter maintenance bundle: Cleanse pts daily with chlorhexidine. Maintain clean, dry dressings. Enforce hand hygiene among health care workers. |
| Ask daily: Is the catheter needed? Remove catheter if not needed or used. |
| Prevention of Ventilator-Associated Events |
| Elevate head of bed to 30-45°. |
| Decontaminate oropharynx regularly with chlorhexidine (controversial). |
| Give “sedation vacation” and assess readiness to extubate daily. |
| Use peptic ulcer disease prophylaxis. |
| Use deep-vein thrombosis prophylaxis (unless contraindicated). |
| Prevention of Surgical-Site Infections |
| Choose a surgeon wisely. |
| Administer prophylactic antibiotics within 1 h before surgery; discontinue within 24 h. |
| Limit any hair removal to the time of surgery; use clippers or do not remove hair at all. |
| Prepare surgical site with chlorhexidine-alcohol. |
| Maintain normal perioperative glucose levels (cardiac surgery pts).a |
| Maintain perioperative normothermia (colorectal surgery pts).a |
| Prevention of Urinary Tract Infections |
| Place bladder catheters only when absolutely needed (e.g., to relieve obstruction), not solely for the provider's convenience. |
| Use aseptic technique for catheter insertion and urinary tract instrumentation. |
| Minimize manipulation or opening of drainage systems. |
| Ask daily: Is the bladder catheter needed? Remove catheter if not needed. |
| Prevention of Pathogen Cross-Transmission |
| Cleanse hands with alcohol hand rub before and after all contacts with pts or their environments. |
aThese components of care are supported by clinical trials and experimental evidence in the specified populations; they may prove valuable for other surgical pts as well.
Source: Adapted from information presented at the following websites: www.cdc.gov/hicpac/pubs.html; www.cdc.gov/HAI/prevent/prevention.html; www.ihi.org.