Ventilator Bundle for prevention of Ventilator Associated Pneumonia
1. Elevation of
the head of the bed: Elevation of the head of the bed has been found
to be correlated with reduction in the rate of ventilator-associated pneumonia.
The recommended elevation is 30 degrees. Head elevation must be ensured for
every patient on Ventilator on daily basis
2. Daily
sedative interruption and daily assessment of readiness to extubate: Reducing sedation
decreases the amount of time spent on mechanical ventilation and therefore the
risk of ventilator-acquired pneumonia is decreased. In addition, weaning
patients from ventilators becomes easier when patients are able to assist
themselves at extubation with coughing and control of secretions.
3. Peptic Ulcer
Disease Prophylaxis: Stress ulcerations are the most common cause
of gastrointestinal bleeding in intensive care unit patients, and the presence
of gastrointestinal bleeding due to these lesions is associated with a
five-fold increase in mortality compared to ICU patients without bleeding.
Applying peptic ulcer disease prophylaxis is therefore a necessary intervention
in critically ill patients
4. Deep Venous
Thrombosis Prophylaxis: There is a higher incidence of deep venous
thrombosis in critical illness. Deep venous thrombosis prophylaxis is applied
in all patients on ventilator
5. Daily oral
care with chlorhexidine: The recommended chlorhexidine solution
strength is 0.12%. Dental plaque bio films are colonized by respiratory
pathogens in mechanically ventilated patients. Dental plaque develops in
patients that are mechanically ventilated because of the lack of mechanical
chewing and the absence of saliva, which minimizes the development of bio film
on the teeth. Dental plaque can be a significant reservoir for potential
respiratory pathogens that cause ventilator-associated pneumonia (VAP). Use of
Chlorhexidine antiseptic acts as an inhibitor of dental plaque formation and
gingivitis
Central Line Bundle for prevention of catheter associated blood stream infections
1. Hand
Hygiene: Washing hands or using an alcohol-based waterless hand cleaner
helps to prevent contamination of central line sites and bloodstream infections
2. Maximal
Barrier Precautions Upon Insertion: For the staff placing the
central line and for those assisting in the procedure, maximal barrier
precautions means strict compliance with hand washing, wearing a cap, mask,
sterile gown and gloves. The cap should cover all hair and the mask should
cover the nose and mouth tightly. These precautions are the same as for any
other surgical procedure that carries a risk of infection. For the patient,
maximal barrier precautions means covering the patient from head to toe with a
sterile drape with a small opening for the site of insertion
3. Daily Review
of Line Necessity with Prompt Removal of Unnecessary Lines: Daily
review of central line necessity will prevent unnecessary delays in removing
lines that are no longer clearly necessary in the care of the patient
Urinary
Catheter Bundle for prevention of catheter associated urinary tract infections
1. Assessment
of the requirement for continuing catheterization: Check the
clinical condition, if urinary catheter is still required. If there are no indications,
then catheter should be removed
2. Checking
whether the catheter has been continuously connected to the drainage system: Urinary
catheter must be continuously connected to the drainage bag
3. Daily meatal
hygiene: Routine daily meatal hygiene is performed
4. Urobag is
regularly emptied in a clean container: The urinary
catheter bag should be emptied regularly, as a separate procedure into a clean
container
5. Hand hygiene
is performed prior to and after each catheter care procedure:
Decontaminate hands (soap or hand rub) before accessing the catheter drainage
system, after glove removal following access to the catheter drainage system.
Surgical care bundle for prevention of surgical site infections
1.
Prophylactic antibiotic: Correct antibiotic prophylaxis given at correct time and discontinued at
correct time significantly reduces the chance of infections at surgical site
2.
No hair shaving: Hair shaving of the surgical site increases risk of infection. Instead
hair clipping shall be performed
3.
Glucose control (peri-operative): Glucose must be kept under control limit to prevent SSI
4.
Normothermia (except cardiac surgery): Normothermia is keeping the condition of normal body temperature. The
post-surgery patients must be kept in an environment with normal temperature
that does not cause increase or decrease in activity of body cells
5.
Pre-op screening for S. aureus or MRSA – If found positive the organism must be decolonized first before operating
