bundle care

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

3. 5 types.
● Central line bundle.
● Bed sores .
● Surgical site infection care.
● UTI care bundle.
● VAP bundle

5. ● Hand hygeine
● Maximal Barrier Precaution.
● Chlorohexidene Skin Antisepsis.
● Optimal catheter site selection.
● Daily review of central line necessity with
removal of unnecessary lines.

6. 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

7. 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. Chlorohexidene 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
•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- 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. STAGES OF BED SORE

19. *Consider all bed-bound persons, or those
whose 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.
* Have had pressure ulcers in the past.

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

21. *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).

22. *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).

23. 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.Use moisturizers for dry skin. Minimize environmental factors leading to dry skin such as
low humidity and cold air.
4. Avoid massage over bony prominences.

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

25. 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.Place at-risk persons on pressure-redistributing mattress and chair cushion surfaces.
4.Use lifting devices (e.g., trapeze or bed linen) to move persons rather than drag them during transfers and
position changes.
5.Use pillows or foam wedges to keep bony prominences, such as knees and ankles, from direct contact with each
other.
6.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.
7. Avoid positioning directly on the trochanter when using the side-lying position; use the 30° lateral inclined
position.
8. 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.
9. Institute a rehabilitation program to maintain or improve mobility/activity status.

26. ● Immediately informed through incident
report form.

28. *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.

29. * 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.

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

31. 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)

32. 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.

33. *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.

34. *Do not 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.

35. *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.

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

39. 1.Identify 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
neurological: debilitated, paralyzed, or
comatose patients to prevent skin breakdown and
infection

40. Hand hygiene and aseptic insertion, maintenance technique, patient
peri cleaning each shift.
Maintain the urine drainage bag below the bladder, off the floor and no
dependent loops in the tubing
Use a securing device to prevent movement of the catheter.
Daily review of catheter necessity and prompt removal of device.

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

42. .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/or nitrate
b. Urine ≥ 10 WBC/mm3

43. *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.

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

45. *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.
Indwelling catheters should be removed as soon as the patient's
clinical condition no longer requires precise output
measurement.

46. Candida spp. and Escherichia coli in the urine is for the most part
a benign process associated with the use of urinary catheters and
antimicrobial therapy.

48. *Maintaining optimal nurse-patient and respiratory
therapist -patient ratios in the ICU may favorably
influence duration of ICU stay and VAP incidence.

49. *Proper Hand washing
*Oral intubation, avoiding unnecessary re-intubation
*Nutritional support with enteral feeding while avoiding
gastric over distension
*Semierect positioning(300 to 450 )

50. *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.

51. *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.