The Bundle “Plus”

Walz, J. Matthias; Ellison, Richard T.; Mack, Deborah Ann; Flaherty, Helen; McIlwaine, John; Whyte, Kathleen G.; Landry, Karen; Baker, Stephen P.; Heard, Stephen O.

doi:10.1213/ane.0b013e3182a8b01b

Cited by 37 publications

(15 citation statements)

References 26 publications

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“…Despite its benefits, the CVC can lead to mechanical or infectious complications. The latter are more frequent and have greater impact on the patient 3 - 4 . Catheter-related bloodstream infection (CRBSI) is a complication that can be related to increases in costs, length of stay and morbidity and mortality rates, especially among ICU patients 5 - 7 .…”

Section: Introductionmentioning

confidence: 99%

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients

Fortunatti

2017

Rev. Latino-Am. Enfermagem

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Objective:To evaluate the impact of the implementation of insertion and maintenance bundles on the rates of catheter-related bloodstream infection in an intensive care unit. Method:This is a quasi-experimental, before-and-after study with a non-equivalent control group. During a six-month period, insertion and maintenance bundles for the central venous catheters were implemented. Supervision guidelines were developed to assess compliance with the bundle and catheter characteristics. Results:A total of 444 central catheters corresponding to 390 patients were observed, of which 68.7% were inserted in the unit. The maintenance and insertion bundles reached 62.9% and 94.7% compliance, respectively, and 50.7% of the insertions were supervised. It was possible to observe a 54.5% decrease in the rate of central catheter infection (3.48 vs 1.52 x 1000 days/catheter, p<0.05) when compared with the control group. Conclusion:The simultaneous implementation of insertion and maintenance bundles has a positive impact on the reduction of catheter-related bloodstream infection; therefore it is an efficient alternative to improve the quality and safety of care in high complexity units.

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Section: Introductionmentioning

confidence: 99%

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients

Fortunatti

2017

Rev. Latino-Am. Enfermagem

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“…These strategies include frequent hand washing before and after care, using maximal sterile barrier precautions upon insertion, using chlorhexidine skin antisepsis, selecting optimal catheter site, cleaning catheter hub before access, reviewing the necessity of the VAD daily, and removing the device if not needed. [1314151617]…”

Section: Venous Access Device Infectionmentioning

confidence: 99%

Venous access devices: Clinical rounds

Matey

Camp-Sorrell

2016

Asia-Pacific Journal of Oncology Nursing

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Nursing management of venous access devices (VADs) requires knowledge of current evidence, as well as knowledge of when evidence is limited. Do you know which practices we do based on evidence and those that we do based on institutional history or preference? This article will present complex VAD infection and occlusion complications and some of the controversies associated with them. Important strategies for identifying these complications, troubleshooting, and evaluating the evidence related to lack of blood return, malposition, infection, access and maintenance protocols, and scope of practice issues are presented.

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“…Institution of checklists, process changes, and audits (bundled approach) have proven to be effective in reducing violations surrounding central lines as well as subsequent infection rates [10,85]. Part of the solution to hand hygiene as well as other violations will be mutual accountability-holding each other to the highest standards in the interest of patient safety [86,87].…”

Section: Personal Readiness Violationsmentioning

confidence: 99%

Improving Patient Safety in the Cardiac Operating Room: Doing the Right Thing the Right Way, Every Time

Wahr

Abernathy

2014

Curr Anesthesiol Rep

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The past 5 decades have seen an incredible advance in cardiac surgery knowledge, techniques, equipment, skill sets, and outcomes. Even as our average cardiac surgery patient becomes older with more significant cardiac disease and medical comorbidities, mortality continues to decrease. However, many of the deaths that do occur have been shown to be preventable. These preventable deaths are more often due to non-technical errors, such as communication failures, distractions, and disruptions, than to a failure of technical skill or knowledge. Further improvements in patient outcome require optimizing team performance, in both what the team does (evidence-based best practices) and how they do it (optimizing team performance, reduction of error, improved tools and technologies). Interventions such as formal team training, checklists, briefings and debriefings, cognitive aids, and handover tools have been shown to decrease disruptions and reduce patient mortality. Optimizing team performance will require adoption of a just culture, where errors are not met with ''blame and shame'' but as due to system hazards to be resolved, but where personal accountability is also present. The journey to habitual excellence should not be viewed as a draconian elimination of human error, but one of continuous optimization of team performance.

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The Bundle “Plus”

Abstract: The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.

Cited by 37 publications

References 26 publications

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients

Venous access devices: Clinical rounds

Improving Patient Safety in the Cardiac Operating Room: Doing the Right Thing the Right Way, Every Time

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