2. What is a bundle?
• A bundle is a structured way of
improving processes of care and
patient outcomes.
• It is a small straightforward set
of practices - generally three to
five - that, when performed
collectively, reliably and
continuously, have been proven to
improve patient outcomes.

3. Who can use the bundles?
• Anyone in the clinical setting
with the agreement of the
clinical team and Quality
Improvement Leads can use the
bundles.

4. Impact of the 4 bundles
Impact on
patient
Impact on
leadership
Impact on
staff
Impact on
system
Impact on
statistics

5. CATHETER ASSOCIATED
URINARY TRACT
INFECTION(CAUTI)

6. Evidence-based Risk Factors
for CAUTI

7. Pathogenesis of CAUTI
• Source of
microorganisms may be
endogenous (meatal,
rectal, or vaginal
colonization) or
exogenous, usually via
contaminated hands of
healthcare personnel
during catheter insertion
or manipulation of the
collecting system

8. CAUTI PREVENTION BUNDLE
Meatal hygiene
Urine bag
emptied
Assess the need
of catheterization

9. Surgical Site Infection
(SSI)

10. Epidemiology: Important Modifiable
Risk Factors
• Antimicrobial prophylaxis Inappropriate
choice (procedure specific)
• Improper timing (pre-incision dose)
• Inadequate dose based on body mass
index, procedures >3h, or increased blood
loss
• Skin or site preparation ineffective
Removal of hair with razors
• Colorectal procedures Inadequate bowel
prep/antibiotics
• Improper intraoperative temperature
regulation

11. Pathogenesis
Pathogen Sources
• Endogenous
– Patient skin flora
– mucous membranes
– GI tract
• Seeding from a distant focus of infection
• Exogenous
– Surgical Personnel (surgeon and team) Soiled
attire
– Breaks in aseptic technique
– Inadequate hand hygiene
• physical environment and ventilation
• Tools, equipment, materials brought to the
operative field

12. SSI PREVENTION BUNDLE
Administration
of antibiotic

13. CENTRAL VENOUS CATHETER
ASSOCIATED
BLOODSTREAM INFECTION

14. Modifiable Risk Factors

15. Pathogenesis
More Common Mechanisms
1. Pathogen migration along
external
surface
- more common early
(< 7days)
2. Hub contamination with
intraluminal colonization
-more common >10 days
Less Common Mechanisms
1. Hematogenous
seeding from another source
2. Contaminated infusates

16. CENTRAL VENOUS CATHETER CARE
BUNDLE

17. PERIPHERAL VENOUS
CATHETER ASSOCIATED
INFECTION

18. MODIFIABLE RISK FACTORS
• Insertion circumstances
• Skill of inserter
• Insertion site
• Skin antisepsis
• Catheter lumens
• Duration of catheter care
• Barrier precautions

19. Pathogenesis: PVC infection
More Common Mechanisms
1. Pathogen migration along
external surface
2. Hub contamination with
intraluminal colonization
Less Common Mechanisms
1. Hematogenous
seeding from another source
2. Contaminated infusates

20. PVC CARE BUNDLE
Necessity
of line

21. VENTILATOR ASSOCIATED
PNEUMONIA

22. Risk factors of ventilator
associated pneumonia

23. Pathogenesis
• Colonization of respiratory and
digestive tracts
• Micro aspiration of secretions of
the upper and the lower parts of
the airway

24. Ventilator associated pneumonia care bundle
asepsis

26. Thank you