Patients receiving infusion therapy (IV) are at a high risk of bloodstream infections.
While there have been many interventions to help reduce this risk, the implementation of care bundles has proven to be an effective intervention.1
What are care bundles and why are they effective?
Care bundles are comprised of 3-5 evidence-based practices that are completed in a standardized way by every healthcare professional. They are used to help prevent the transmission of bacteria. This bundle is used on every patient, every time to help improve patient safety.2,3
Over time, the original bundle concept has been simplified into patient or procedure checklists. The differentiating factors between a bundle and a checklist is when a bundle element is missed, there is a great risk to patient safety.4,5,6
For example, the COVID pandemic safety bundle includes: meticulous hand hygiene, wearing a mask, social distancing, disinfecting surfaces, and health checks. If one of these elements is missed, the individual and the public are at a greater risk of exposure. Each step of the process is critical to helping reduce risk.
Core elements of a care bundle.
Patients with a vascular access device (IV) are at risk of infection or other complications that may increase their morbidity and mortality. Pronovost et al. (2006) developed the first care bundle for central vascular access device (CVAD) insertion in 2002.7 While there have been a number of local modifications, the original core elements remain.7
In addition to hand hygiene, the core elements include:8
- Chlorhexidine skin antiseptics
- Optimal site selection (avoidance of femoral vein in adults)
- Maximum full barrier drapes
- Sterile transparent dressing
- CHG dressing at the insertion site
Eggiman et al. (2019) and Ista et al. (2016) use evidence that supports the use of a CVAD maintenance bundle to reduce and prevent central line associated bloodstream infection (CLABSI).8,9 Hand hygiene is the first step, along with:
- Assessing the need for an IV daily
- Monitoring for signs of complication
- Checking dressing integrity
- Using chlorhexidine infused dressings
- Implementing aseptic hub access with disinfection caps
Implementing similar bundles for peripheral vascular access devices (PVADs) insertion and maintenance have been shown to help reduce blood stream infection.10,11 However, the efficacy for reducing early failure (catheter removal before intended treatment is completed) has shown mixed results.2,11,12.
Standardized VAD insertion and maintenance bundles help simplify infection control and ensure consistency of practice, resulting in improved patient outcomes.
To learn more about care bundles and helping prevent bloodstream infections, contact a representative by filling out the form below.
- Haraden C. 2019. What is a bundle: Improvement stories. Institute for Healthcare Improvement (IHI). http://www.ihi.org/resources/Pages/ImprovementStories/WhatIsaBundle.aspx Accessed, 2 Feb, 2021.
- Ray-Barruel G, Xu H, March N et al. 2019. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Inf, Disease, Health; 24(3): 152-168
- Resar R, Griffin F, Haraden C, Nolan T. 2012. Using care bundles to improve health care quality. IHI Innovation Series white paper. Institute for Healthcare Improvement, Cambridge, Massachusetts.
- Buckwalter KC, Cullen L, Hanrahan K, et al. 2017, Iowa model of evidence-based practice: Revisions and validation. Worldviews on evidence-based nursing; 14(3): 175-182.
- Dontje, Katherine J. 2007. Evidence-based practice: understanding the process: implementing evidence-based practice: The Iowa Model. http://www.medscape.com/viewarticle/567786_4.
- Savage T, Hodge DE, Pickard K et al. 2018. Sustained reduction and prevention of neonatal and pediatric central line-associated bloodstream infection following an nurse-driven quality improvement initiative in a pediatric facility. JAVA; 23(1):30-41.
- Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-2732.
- Eggimann, P., Pagani, JL., Dupuis-Lozeron, E. et al. Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years. Intensive Care Med 45, 823–833 (2019). https://doi.org/10.1007/s00134-019-05617-x
- Ista E, van der Hoven B, Kornelisee RF, et al. 2016. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis.; 16:724-734
- Duncan M, Warden P, Bernatchez SF, Morse D. 2018. A bundled approach to decrease the rate of primary blood stream infections related to peripheral intravenous catheters. JAVA; 23(1):15-22.
- Kleidon TM, Cttanach P, Mihala G, Ullman AJ. 2019. Implementation of a paediatric intravenous catheter care bundle: a quality improvement initiative. J Paed & Child Health; Oct: 1214-1223
- Othman WN, Awad SA. 2017. Effect of execution of the peripheral intravenous cannula care bundle on reducing the incidence of infection. IOSR J Nsg Health Science; 6(6): 67-74