Search

The aim of this integrative review was to explore the effect of care bundles in the prevention of Medical Device Related Pressure Ulcers (MDRPU). An MDRPU is a wound that occurs on the skin or mucosal membranes because of pressure or pressure in combination with shear. Like other types of pressure ulcers, they will have negative consequences for patients and healthcare organisations alike. Many MDRPU's are preventable. A literature search was undertaken from computerised databases using key search terms, Pressure Ulcer* Pressure Injur* and Medical Device*. Databases included CINAHL; Medline and SocIndex. A total of seven studies were found that met the criteria for inclusion in this review. When compared to the widely recognised and trusted international guidelines there was variation found between the individual interventions selected within each study for inclusion within the bundle. Skin assessment and device repositioning were the most frequently included interventions in the bundles, followed by use of prophylactic dressings, appropriate device selection and fitting. The least common intervention was monitoring the tension of the device and/or its securements. All studies reported a reduction in the number of MDRPU's when care bundles were used in clinical practice. However, there is variation in bundle designs and study methodologies employed. This review has demonstrated the potential benefit of care bundles in reducing MDRPU. However, due to heterogeneity in the study methods employed and the interventions within the care bundles, further, more robust research is required to establish which interventions show the most clinical and patient benefit. • Medical Device related pressure ulcers will have a negative impact on patients and healthcare organisations. • Medical Device related pressure ulcers can be prevented. • Multi intervention care bundles can reduce rates of MDRPU's. • Variation exists between the recommended guidelines and prevention strategies used in clinical practice. [ABSTRACT FROM AUTHOR]

Care bundles are a promising approach to reducing postpartum hemorrhage–related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment. We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles. Peer-reviewed studies evaluating postpartum hemorrhage–related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible. Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively. Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32–0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57–0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution. The E-MOTIVE intervention improves postpartum hemorrhage–related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated. [Display omitted] [ABSTRACT FROM AUTHOR]

Obstetric sepsis is a leading cause of maternal mortality and severe maternal morbidity in the United States. However, it is uncommon, and diagnosis and treatment are often delayed. This report summarizes recent work to develop a patient-centered approach for the care of patients with obstetric sepsis. To support patients, educational materials to identify warning signs paired with advocacy tips are important. Following an adverse event, outlines and checklists for patient support are provided. These tools have been developed to address a variety of obstetric conditions and have utility beyond sepsis. On the clinical side, new data to establish a standardized approach to screening and diagnosis is covered in detail. This "two-step" approach has been supported by national obstetric organizations and has similarities to the algorithm used to screen neonates for term early onset sepsis. In addition, the approach for implementation of a sepsis care bundle by the California/Michigan Obstetric Sepsis Quality Collaborative is discussed. [ABSTRACT FROM AUTHOR]

• Hospital accreditation showed the strongest independent association with infection control knowledge among nurses. • Nurses' experience, areas of work, and hospital teaching status have an independent association with infection control knowledge. • Infection control knowledge is not impacted by the type of city one works in India, has been a rewarding finding. • Stringent infection control training sessions are recommended at all levels of nursing and infection control programs should be mandatory in Critical care teaching curriculum. • Our study serves as a baseline for future evaluations and provides a basis for policy makers to implement strategies to improve infection control in the key areas of the hospital. Healthcare-associated infections (HAIs) are a significant threat in healthcare settings. Since nurses have the most day-to-day contact with patients, their knowledge about infection control (IC) practices is crucial in preventing HAIs. We therefore conducted a study to assess the knowledge and awareness of IC practices amongst nurses across hospitals in India. An online survey-based, cross-sectional, descriptive study for nurses was conducted in July-August 2021, through a multiple-choice questionnaire, administered via a web-based link across 13 hospitals from various cities of India. Five different aspects of IC knowledge were assessed including general IC, standard precautions, transmission-based precautions, bundle care knowledge, and COVID-19 related knowledge. Complete data filled by 1,000 nurses was analyzed. The knowledge of nurses varied across different aspects of IC. A statistically significant association was found between the IC knowledge and the years of experience (P =.003) and the area of working (critical vs semi-critical areas) (P <.001) of nurses. A statistically significant difference was also found in the knowledge of nurses from different hospitals depending upon the accreditation (P <.001) and the teaching status (P =.035), but no significant difference based on the city category of hospital (P >.05). Accreditation showed the strongest association {β = 2.499 (95% CI = 1.67-3.32)} while non-teaching status had a negative impact {β = -1.76 (95% CI = 2.543 to -2.543)} on knowledge using multivariate linear regression analysis. Infection prevention and control is the biggest challenge in any hospital and improving the knowledge and awareness of the nurses on the same is fundamental to its success. A multifaceted approach of continuing education programs, training, and feedback should be undertaken towards improving the awareness and compliance to IC practices. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheter (PIVC) insertion is the most frequently used method for intravenous (IV) treatment in pediatric patients. Purpose: The aim of this study was to determine the effect of the Intravenous Infiltration Management Program on the success of PIVC insertion and infiltration in infants. Methods: The study was carried out using a quasi-experimental design with pretest-posttest control groups and included 750 PIVC procedures for 218 infants between 28 days and 12 months of age. Results: The program decreased the number of PIVC insertions per patient, although it was not statistically significant (P = .076) and had an impact on the success of the PIVC attempt (P < .001), first PIVC attempt (P < .001), PIVC dwell time, and early detection of infiltration (P < .001). Conclusion: The program is effective in the success of the PIVC insertion process and early detection of infiltration. [ABSTRACT FROM AUTHOR]

Abstract In 2014–2015 the NHS carried out 9.9 million operations. Hospital-acquired infection (HAI) though, continues to be a major challenge, with 300,000 patients a year affected. The human cost is enormous, but so is the financial cost; HAIs are estimated to cost the NHS approximately £1–2 billion a year, with £56 million of this estimated to be incurred after patients are discharged from hospital. Many HAI are preventable, and this article aims to support the surgeon and team in reducing HAI in the surgical pathway, by reviewing the role of intrinsic and extrinsic factors in the development of a HAI, to enable prevention/mitigation strategies to be put in place to ensure the safest possible care pathways. [ABSTRACT FROM AUTHOR]

Abstract Objectives The purpose of this study was to develop, validate and apply a ventilator-associated pneumonia prevention checklist in a single cardiac surgery centre. Methods An initial checklist was designed based on the published care bundles for prevention of ventilator-associated pneumonia; the Delphi method used for validation. A total of 20 experts were invited to score the items and give suggestions for the checklist. The final checklist was then applied to patients receiving cardiac surgery. Non-compliance with the protocol and outcome indicators were observed. Results Two rounds of Delphi were conducted. The final one-page checklist consisted of three main parts: (1) demographic data of the patient receiving cardiac surgery; (2) general assessment of the patient (3) checklist of prevention measures. The average time to complete the checklist was between two and four minutes. After the application of the checklist, the incidence of ventilator-associated pneumonia decreased from 14.48 to 5.47 episodes per thousand ventilator hours. In patients requiring >48 hours mechanical ventilation, the ventilator-associated pneumonia rate and duration of ventilation was significantly decreased. Conclusion A checklist was developed for ventilator associated pneumonia based on care bundles and validated using the Delphi method. The checklist appeared to be a useful tool in preventing ventilator associated pneumonia and shortening the ventilation time. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgical site infections (SSIs) have devastating consequences and present several challenges for patients and healthcare providers. Adult cardiac SSI surveillance commenced in 2009 at our hospitals, Guy's & St Thomas' NHS Foundation Trust, London, as a patient safety initiative amid reported increased incidence of SSIs. Before this time, infection incidence was unclear because data collection was not standardized.Aim: To standardize SSI data collection and establish baseline SSI rates to facilitate deployment of evidence-based targeted interventions within clinical governance structures to improve quality, safety, and efficiency in line with our organizational targets.Methods: We standardized local data collection protocols in line with Public Health England recommendations and identified local champions. We undertook prospective SSI surveillance collaboratively to enable us to identify potential practice concerns and address them more effectively through a series of initiatives. Clinical staff completed dedicated surveillance forms intraoperatively and postoperatively.Findings: Overall adult cardiac SSI rates fell from 5.4% in 2009 to 1.2% in 2016 and coronary artery bypass graft rates from 6.5% in 2009 to 1.7% in 2016 (P < 0.001). Gram-negative bacteria were recognized as important SSI causative organisms and were better controlled after introducing stringent infection control measures.Conclusion: Comprehensive, evidence-based infection control practices were successfully implemented through a multidisciplinary collaborative approach, which may have great potential to reduce Gram-negative, Staphylococcus aureus, polymicrobial and overall SSI burden and/or associated costs. We now investigate all SSIs using an established SSI detailed investigation protocol to promote continual quality improvement that aligns us perfectly with global efforts to fight antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a “care bundle” approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. Methods All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed. Results A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively ( P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 ( P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days ( P < .0001) after implementation of the care bundle. Conclusions This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections. [ABSTRACT FROM AUTHOR]

Neonatal abstinence syndrome (NAS) is a growing public health concern, one that costs the health care system $190-$720 million each year. Recently, state-level perinatal quality collaborative groups have disseminated NAS action plans: customizable frameworks aimed to assist health care systems in identifying, evaluating, treating, and coordinating discharge services for neonates with NAS. Hospital-based neonatal nursing quality improvement teams, including neonatal nurse practitioners (NNPs), neonatal clinical nurse specialists (CNSs), and clinical neonatal nurses, by virtue of their collective academic, administrative, and practical years of experience, are ideally positioned to develop, implement, and evaluate NAS care bundles. The article's purpose is to discuss key elements of an NAS care bundle using the framework of the Perinatal Quality Collaborative of North Carolina NAS action plan as an exemplar. Discussion of evidence-based and nursing-driven metrics will be followed by a discussion of the emerging concept of an inpatient-to-outpatient transitional care NAS management model. [ABSTRACT FROM AUTHOR]

Nursing graduates transitioning to practice are expected to be safe and competent practitioners. Health organizations promote the use of evidence-based practices such as care bundles to improve patient outcomes and provide quality health care. This research describes the introduction of 2 care bundles, sepsis, and acute stroke to senior associate degree nursing students in a clinical day on campus. The researchers used high-fidelity simulation as a teaching methodology to increase knowledge and confidence level in caring for patients in the clinical setting. [ABSTRACT FROM AUTHOR]

Aims: The Rapid Response to Acute Illness (RRAILS) Programme is a quality and service improvement initiative which is participated in by all Welsh healthcare organisations including the Welsh Ambulance Service Trust (WAST) and Velindre Cancer Centre. The aims of the programme were and are: Implementing the National Early Warning Score (NEWS) as standard in all clinical areas in all 18 acute hospitals. Quantifying the incidence of sepsis and acute deterioration in the non Critical Care setting. Improving reliability of systems for identification, escalation and treatment of sepsis. Demonstrably improving outcomes from sepsis and other causes of acute deterioration. Methods: Clinical teams participated in learning sets at which they were trained in service improvement and human factors principles and then supported to implement 'bundles' of best evidence whilst measuring both processes and outcomes. Findings: All organisations have implemented standardised tools and operating procedures including NEWS, sepsis screening tools, Patient Status at A Glance (PSAG) boards, sepsis response bags and an antibiotic formulary. All organisations have demonstrated improvements in the reliability of detection and escalation of acute deterioration whilst many have started to demonstrate local improvements in outcomes. Conclusion: The collaborative learning set is an effective method for improving quality of sepsis care throughout a single healthcare economy. [ABSTRACT FROM AUTHOR]

Central venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear. This study was aimed to describe clinicians' adherence to recommended practices in central venous catheter insertion and management. A cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools. Our audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants' practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation. Our audit showed a detailed picture of clinician's adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit. [ABSTRACT FROM AUTHOR]

Summary: Background: The threat of hospital-acquired infections persists despite advances in the health care system. A lack of knowledge regarding infection control practices among health care workers decreases compliance with these practices. We conducted a study to assess the knowledge of infection control practices among nursing professionals at our hospital. Methods: In total, 100 nurses in the intensive care units at our hospital were given a questionnaire with 40 multiple choice questions, including 10 questions each regarding hand hygiene, standard and transmission-based precautions, care bundles and general infection control practices. The responses were scored as percentages. Results: The overall knowledge and awareness regarding different infection control practices were excellent (>90% positive responses) in 5% of the nursing professionals, good (80–90% positive responses) in 37%, average (70–80% positive responses) in 40% and below average (<70% positive responses) in 18%. Conclusion: The infection control knowledge among the nurses was fairly good; however, there is still a wide scope of improvement with regular educational programs and in-house training. [Copyright &y& Elsevier]

Abstract: Background: Although there is a wealth of guidance concerning the management of patients with ventilator-associated pneumonia (VAP), compliance with recommendations concerning optimal treatment practices is highly variable. Methods: This document presents a comprehensive care bundle package addressing all aspects of VAP diagnosis and treatment in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalized method to assess the supporting data, based on multicriteria decision analysis. Results: This system allowed the numerous VAP management parameters identified from recent European guidelines to be ranked according to defined criteria. The resulting VAP care bundles are (a) diagnosis: early chest x-rays within 1 hour, immediate reporting of respiratory secretions Gram staining, and (b) therapy: immediate treatment, empiric therapy based on local pathogens and risk factors, de-escalation, assessment of response within 72 hours, and short therapy duration if feasible. Conclusion: Adoption of these care bundles should rationalize VAP management practices and facilitate the development of consistent and guideline-compliant care processes. [Copyright &y& Elsevier]

Summary: Huge success has been noted internationally in reducing catheter-related bloodstream infection with ‘care bundles’ for central venous catheters in intensive care units. A multidisciplinary team from the Infectious Diseases Unit at Ninewells Hospital, Dundee designed a ‘bundle’ for peripheral venous catheters (PVCs) based on drafts developed by Health Protection Scotland (details available online). A senior medical student collected weekly data, carried out monthly ‘plan, do, study, act’ (PDSA) cycles and displayed the results on the ward in real time. Data consisted of measures to assess objectively clinical performance for insertion (recording date, indication and location) and maintenance (daily review of necessity, clinical appearance of site, duration less than 72h and timely removal). Care bundle compliance was assessed for each patient and percentage compliance plotted weekly. The initial compliance of 54% improved by 1.11% per week to 82% (95% confidence interval: 0.6–1.6%; P =0.0001). This was attributed to multiple interventions including daily assessment of PVC necessity, weekly audit and feedback, monthly patient safety meetings to discuss issues with compliance, the introduction of new PVC dressings and the promotion of new PVC care plans. In conclusion, we demonstrated a significant improvement in PVC management on a single unit by using a care bundle approach. In order to improve compliance, further implementation of the PVC care bundle throughout the hospital has been necessary. [ABSTRACT FROM AUTHOR]

Abstract: Severe sepsis and septic shock are syndromes resulting in a systemic inflammatory response and the dysfunction of one or more organs following infection. The Surviving Sepsis Campaign is an international effort to reduce mortality in severe sepsis and septic shock by 25% by 2009 using a care bundle approach. It comprises evidenced-based interventions to be carried out within 6h of onset of sepsis. We conducted a prospective observational audit of 32 consecutive adult patients with severe sepsis or septic shock admitted via the A&E of a district general hospital. The compliance rate against each element, and overall compliance to the 6-h bundle were obtained. Patients’ ages ranged from 55 to 75 years with 53% being male. Overall compliance was 19%. Arterial lactate was undertaken 100% of the time, and only just over half received an appropriate fluid challenge. Administration of an antibiotic was also very slow. Local recommendations include improvements to the track and trigger scoring system in A&E to improve recognition of sick patients, ensuring the doctor responsible for prescribing the antibiotic will administer it, and increasing awareness of the surviving sepsis campaign via education and training of all A&E staff. Given current evidence greater compliance to the care bundle may well improve patient outcomes for this client group. [Copyright &y& Elsevier]

Abstract: Sepsis is one of the most frequent causes of unplanned ICU admission. It is responsible for more than 65,000 admissions annually in the UK and an estimated 750,000 in the USA, with a reported mortality of between 28% and 50%. The pathophysiology of sepsis results from a complex interaction of cellular and inflammatory mediators. Early identification of severe sepsis should improve survival. However, the diagnosis is not always straightforward. The treatment priorities in severe sepsis can be summarized as: prompt recognition and early resuscitation; appropriate antibiotic therapy after obtaining specimens for culture; search for and treatment of focus of infection; adjunctive therapies, including recombinant human activated protein C, steroids and blood glucose control; support for failing organ systems. The Institute for Healthcare Improvement promotes the use of care bundles to encourage change in current practice. Genetic markers that will allow the determination of the host response and provide a key for subsequent treatment may become available in the future. [Copyright &y& Elsevier]

Highlights • Severe sepsis is a major cause of morbidity and mortality. • The impact of the severe sepsis 3-hour care bundle on sepsis patient mortality was examined. • Severe sepsis patients who received the 3-hour bundle had improved outcomes over those who did not. Severe sepsis is a major cause of mortality among hospitalized patients. We tracked severe sepsis 3-hour bundle compliance and mortality over time. Those patients with severe sepsis who received the entire bundle had improved in-hospital survivability over those patients who did not receive the bundle. [ABSTRACT FROM AUTHOR]