Prevention of hospital-acquired infections: Implementation of critical care nursing bundles to prevent ventilator, central line, and foley infections

Author(s): Laura Chung

Statement of the Problem: Hospital Acquired Infections (HAIs) are life-threatening to patients. In the United States, an average of 1.7 million HAIs occur annually; 99,000 deaths result from these infections. The most common sites of these infections are: urinary catheters (32%), surgical sites (22%), lung/ ventilator infections (15%), and bloodstream/central lines (14%). These infections occur in all types of settings, from hospitals to nursing homes and rehab centers. Nurse driven bundles have proven successful in decreasing the occurrences of HAIs. These bundles involve collaboration with other interdisciplinary members of the healthcare team, such as respiratory therapists. Ventilator bundle elements include: CHG mouthwash prior to intubation, mouthcare and documentation q2-4 hours by the RN and RT, head of bed elevation to 30 degrees, and continued CHG mouthwash for 24 hours after extubation. Urinary catheter bundles include: 2 nurse insertion, CHG catheter care documented q8 hours, daily assessment of need, use of securement device, and use of less invasive devices, such as the Purewick device. Methodology & Theoretical Orientation: Critical care nurses at John Muir Health implement these bundles based on their patients’ needs. For example, an intubated patient with a Foley catheter and central line will get all three bundles of care implemented. Bundles are documented in the medical record at certain intervals.