Bundle is Structure way of Improving Process of Care and Patient Outcome To improve patients outcome

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2. Definition
Evidence-Based Care Bundles
A bundle is a structured way of improving the processes of
care and patient outcomes: a small, straightforward set of
evidence-based practices — generally three to five — that,
when performed collectively and reliably, have been proven
to improve patient outcomes.
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3. Aim
Care bundles aim to ensure that patients receive
recommended treatments on a consistent basis
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4. Characteristic
It is recommended that when planning bundle-based
care, each aspect be well defined and based on
evidence from at least 1 systematic review of multiple
well-designed randomized controlled trials (RCT) or on
data from at least 1 well-designed RCT
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5. List
1 •Central line
2 •Urinary catheter
3 •Mechanical ventilation
4 •Surgical procedures
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6. CAUTI
*Assess daily necessity of indwelling catheter
*Use sterile technique for catheter insertion
*Maintain a sterile closed drainage system
*Position drainage bag below the level of the bladder
*Secure indwelling catheter
*Ensure daily catheter care hygiene measures
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7. CAUTI Bundle
• Insert catheters only for appropriate indications
• Leave catheters in place only as long as needed
• Properly trained persons insert and maintain catheters
• Insert catheters using aseptic technique
• Maintain a closed drainage system
• Maintain unobstructed urine flow
• Hand hygiene and Standard Precautions
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8. CLABSI
*Hand hygiene
*Maximal barrier precautions upon insertion
*Chlorhexidine skin antisepsis
*Optimal catheter site selection (subclavian vein is the
preferred site for non-tunneled catheters)
*Daily review of line necessity and prompt removal of
unnecessary lines
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9. Central line Bundle
O Promptly remove unnecessary central lines
O Follow proper insertion practices
O Handle and maintain central lines appropriately
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10. SSI
*Monitor appropriate use of antibiotics before and
after surgery
*Eliminate the use of razors to remove hair (can nick
the skin and lead to infection)
*Keep the patient warm during surgery
*Monitor the patient's blood sugar after surgery
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11. SSI Bundle
Administer antimicrobial prophylaxis
Remote infections-whenever possible
Do not remove hair at the operative site
Skin Prep;do not use razor
Maintain immediate postoperative normothermia
Operating Room (OR) Traffic
Surgical Wound Dressing
Control blood glucose level during the immediate
Post-operative period
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12. VAP
1.Elevation of the head of the bed (HOB)
2. Daily sedation vacations and assessment to extubate
3. Peptic ulcer disease prophylaxis
4. Deep vein thrombosis (DVT) prophylaxis
5. Daily oral care with chlorhexidine (added in 2010)
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13. Bundle Controversies
1-A number of different bundles exist, some targeting the same
clinical condition.
2Differences in these bundles can lead to variability in bundle
compliance rates and confusion when institutions attempt to
benchmark performance.
3In addition, while it is maintained that a bundle encompasses a series
of "proven" practices, healthcare clinicians need to evaluate the
evidence behind the bundle components.
4-A scattering of clinical trial evidence exists for some of the
components and the strength of evidence for each component
varies.
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14. Strategies for Promoting Bundle
Forming a committee to:
I. Review bundle care recommendations,
II. Compare them to current unit practices,
III. Generating a timeline for implementation,
IV. Providing education and communication to unit staff,
V. Conducting audits to assess compliance with bundle ,
VI. Regularly reporting the results back to unit staff.
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15. Thank you
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