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Background: Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. Methods: A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48 h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. Results: A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. Conclusion: The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation. [ABSTRACT FROM AUTHOR]

Abstract Background Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. Methods A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48 h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. Results A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. Conclusion The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

Background: External ventricular drain (EVD)-related infection (ERI) is a common complication in cranial neurosurgery practice with high mortality. The risk factors associated with ERI are not well studied in low- and middle-income countries (LMIC) like India. Identifying the risk variables is a necessity to design robust evidence-based care bundles for ERI prevention. Materials and methods: This is a single-center prospective cohort study. Patients with and without ERI during the 2-year study period were analyzed along with literature review to identify the risk variables associated with ERI. The Institute for Healthcare Improvement (IHI) comprehensive flowchart was used to develop the concept care bundle for ERI prevention. Results: A total of 211 EVD were inserted during the study period. 15 ERI (7.1%) were identified based on IDSA criteria, with an average infection rate of 11.12 per 1000 EVD days. Gram negative bacteria (GNB) were the predominant pathogen (12/15, 80%), with Klebsiella pneumoniae (6/15, 40%) being the most common bacteria isolated. In multivariate analysis, the risk variables associated with ERI were use of broad spectrum pre-surgical antimicrobial prophylaxis for long duration, choice of posterior craniometric points for EVD insertion, EVD duration >7 days, EVD leak and surveillance cerebrospinal fluid (CSF) sampling at periodic intervals. Based on the risk variables identified in this study and literature review, a consensus decision on the care elements for the insertion and maintenance phases was chosen for the concept care bundle for ERI prevention. Conclusion: An evidence-based concept care bundle for ERI prevention is proposed for further multicentric evaluation and validation. [ABSTRACT FROM AUTHOR]

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]

Objective To investigate the effect of care bundles based on the concept of enhanced recovery after surgery in perioperative nursing of patients undergoing laparoscopic cholecystectomy. Methods A total of 260 cases of laparoscopic cholecystectomy were randomly divided into observation group (n=130, received routine nursing care) and control group (n=130, received care bundles based on the concept of enhanced recovery). Postoperative recovery condition, incidence of complications and postoperative pain were compared between the two groups. Results At 2, 6 and 24 h after surgery, the Visual Analogue Scale of pain in the observation group were lower than those in the control group, with a significant difference(P＜0. 05). The time to first postoperative exhaustion, time to off-bed activities and hospital stays in the observation group were shorter than those in the control group (P＜0. 05). The incidence of vomiting, incision infection, and bile leakage in the control group was significantly higher than that in the observation group, with a significant difference (P＜0. 05). Conclusion The application of care bundles based on the concept of enhanced recovery after surgery are conducive to the postoperative recovery of patients undergoing laparoscopic cholecystectomy, as well as the improvement of postoperative quality of life. (目的 探讨基于加速康复外科理念的集束化干预措施在腹腔镜胆囊切除患者围术期护理中的应用效果。方法 选取2021年1月—2023年1月某三甲肝胆专科医院收治的260例行腹腔镜胆囊切除术的患者为研究对象, 随机分为两组: 对照组(n=130)围手术期间给予常规护理; 观察组(n=130)实施基于加速康复外科理念的集束化干预措施。比较两组术后恢复情况、并发症发生率以及术后疼痛情况。结果 术后2 h、6 h、24 h观察组患者疼痛视觉模拟(VAS)评分低于对照组, 差异有统计学意义(P＜0. 05)。与对照组相比, 观察组患者术后排气时间、下床时间和住院天数均缩短, 差异有统计学意义(P＜0. 05)。对照组呕吐、切口感染与胆漏发生率高于观察组, 差异有统计学意义(P＜0. 05)。结论 基于加速康复外科理念的集束化干预措更有利于患者术后康复, 提高术后生活质量 。)

This paper summarized the integrated traditional Chinese and western medicine nursing bundles for a patient undergoing percutaneous coronary intervention for acute myocardial infarction. The basic nursing plan was formulated based on a comprehensive nursing risk assessment. Integrated traditional Chinese and western medicine nursing bundles included monitoring of vital signs, postoperative health education, intra-aortic ballon pump-associated catheter maintenance, skin care, Psycho-Cardiology care and interventions on sleep quality, abdominal distension, chest tightness and difficulty breathing syndrome. The integrated traditional Chinese and western medicine nursing bundles are effective to relieve the symptoms, reduce the postoperative complications and improve the prognosis and quality of life of the patient undergoing percutaneous coronary intervention for acute myocardial infarction. (本文总结1例急性心肌梗死患者经皮冠状动脉介入治疗术后中西医结合集束化护理体会。在完善护理评估的基础上, 制定基础护理方案。在密切监测病情的基础上, 实施集束化护理措施, 包括术后健康宣教、主动脉内球囊反搏(IABP)管路护理、皮肤护理、双心护理、睡眠护理, 以及针对腹胀、胸闷憋喘症状的干预等, 旨在有效缓解症状, 减少并发症、后遗症等的发生, 改善预后和患者生活质量。)

Background/Objectives: Hemoperfusion (HP) is employed to modulate cytokine storms in severe coronavirus disease 2019 (COVID-19) patients, requiring careful attention for success and safety. Therefore, we investigated whether our care bundles could enhance HP performance. Methods: We conducted a retrospective cohort study on adult patients (≥20 years old) with severe COVID-19 pneumonia. In the first wave (Phase I), we identified HP-related issues and addressed them with care bundles in the second wave (Phase II). The care bundles included early temperature control, precise hemodynamic monitoring, and clot prevention measures for the HP membrane. The HP success rate and associated adverse events (AEs) were assessed between the two phases. Results: The study included 60 HP (HA330) sessions from 27 cases (Phase I: 21 sessions from 9 cases; Phase II: 39 sessions from 18 cases). Patient characteristics and treatments for COVID-19 were similar, except for baseline body temperature (BT) and heart rate (HR). Phase II showed a higher success rate (67% vs. 89%, p = 0.19), although it did not reach statistical significance. Phase I recorded a significantly higher frequency of AEs (3 [IQR 1, 4] events/case vs. 1 [IQR 0, 2] events/case, p = 0.014). After implementing the care bundles, hypothermia significantly decreased (78% vs. 33%, p = 0.037), with an adjusted odds ratio of 0.15; 95% CI 0.02–0.95, p = 0.044 for baseline BT. Conclusions: Further exploration with a larger sample size is required to establish the advantages of care bundles. However, the bundles' implementation has significantly improved hypothermia prevention. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) represent a burden to the health economy and patients alike. Despite national and international guidelines regarding the management of risk, the incidence and prevalence across England remains high. Detecting early the risk of PUs is paramount, and requires using a valid risk assessment tool alongside clinical judgement and management of associated risk factors. There is a need to implement prevention strategies. Introducing care bundles for pressure ulcers, for example SKIN, SSKIN and most recently aSSKINg, is designed to guide clinicians and reduce variations in care. This article presents a review of the evidence on compliance with guidelines, frameworks, pathways or care bundles within primary and secondary care settings. This article focuses on the literature review that was conducted to inform a subsequent clinical audit of compliance with the aSSKINg framework in a Community NHS Foundation Trust in the South East of England. [ABSTRACT FROM AUTHOR]

Ventilator associated pneumonia (VAP) leads to an increase in morbidity, mortality, and healthcare costs. In addition to increased evidence from the latest European and American guidelines (published in 2017 and 2022, respectively), in the last two years, several important clinical experiences have added new prevention tools to be included to improve the management of VAP. This paper is a narrative review of new evidence on VAP prevention. We divided VAP prevention measures into pharmacological, non-pharmacological, and ventilator care bundles. Most of the effective strategies that have been shown to decrease the incidence of complications are easy to implement and inexpensive. The implementation of care bundles, accompanied by educational measures and a multidisciplinary team should be part of optimal management. In addition to ventilator care bundles for the prevention of VAP, it could possibly be beneficial to use ventilator care bundles for the prevention of noninfectious ventilator associated events. [ABSTRACT FROM AUTHOR]

We conducted a meta‐analysis to assess the effects of bundle‐care interventions on pressure ulcers in patients with stroke to provide a basis for clinical work. Randomised controlled trials on the effects of bundle‐care interventions in patients with stroke were identified using computerised searches of the PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP and Wanfang databases, from the time of inception of each database to July 2023, supplemented by manual literature searches. Two researchers independently retrieved and screened the articles, extracted the data and evaluated the quality of the included studies. After reaching consensus, meta‐analysis was performed using RevMan 5.4. Twenty‐four papers were included, involving 3330 patients of whom 1679 were in the intervention group and 1651 were in the control group. The results showed that, compared with standard care, bundle‐care interventions significantly reduced the incidence of pressure ulcers (3.28% vs. 14.84%, odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.14–0.26, p < 0.001), and aspiration (5.60% vs. 18.84%, OR: 0.25, 95% CI: 0.17–0.39, p < 0.001), and improved patient satisfaction with nursing care (96.59% vs. 84.43%, OR. 5.45, 95% CI: 3.76–7.90, p < 0.001). Current evidence suggests that care bundles are significantly better than conventional nursing measures in preventing pressure ulcers and aspiration, and improving patient satisfaction with nursing care in patients with stroke, and are worthy of clinical promotion and application. [ABSTRACT FROM AUTHOR]

Background Care bundles, introduced in 2001, are described as a set of at least three evidence-based healthcare interventions delivered together in a clinical care episode by all healthcare providers. Although widely implemented in some healthcare areas, care bundle use in maternity care appears relatively recent. To identify the types of care bundles that have been developed, evaluated, or implemented for women during the perinatal period, we undertook a scoping review. Methods Joanna Briggs Institute methodological guidance for scoping reviews was used. MEDLINE, CINAHL, Embase, Maternity and Infant Care, and Epistemonikos were searched from January 2000 to October 2023. Records that reported on women during pregnancy and up to six-weeks postpartum as the intended or actual recipients of a care bundle, were included. The concept of interest was development, evaluation, or implementation of a care bundle. The context was maternity care provision, in any setting or geographical location. Results The search yielded 147 eligible records of which 69 originated in the USA. Most records were concerned with care bundle evaluation (n=74), and most were published in the last five-years (n=95). Eleven categories of clinical conditions were identified. These were surgical site infection, obstetric haemorrhage, perineal trauma, sepsis, stillbirth, hypertension, safe reduction of caesarean section, enhanced recovery after caesarean, placenta accrete, perinatal anxiety/depression, and ‘other’ which contained 21 records reporting on care bundles for one clinical condition. Few clinical conditions had good overlap of care bundle elements. Systematic reviews based on data from non-randomised studies may be feasible for some clinical conditions. Conclusions This scoping review provides comprehensive insight on care bundles in maternity care. Few studies were found that evaluated the effectiveness of these bundles, and many bundles for similar clinical conditions contained diverse elements. A more global approach to care bundle development, evaluation, and implementation in maternity care is recommended.

Objective To investigate the effect of care bundles in fall risk management of inpatients in Department of Neurology. Methods Totally 260 inpatients with high risk of falling were randomly divided into the control group and observation group, with 130 cases in each group. All patients received routine nursing strategy for fall prevention. Based on the literature review and interview analysis, intervention strategy with care bundles was established to enhance the fall prevention. Incidence of in-hospital fall status and patient satisfaction were measured and compared between two groups. Results The incidence of in-hospital fall status in the observation group was lower than that in the control group (13. 85% vs. 27. 69%, P＜0. 05). The score of satisfaction assessment in the observation group was higher than that in the control group(P＜0. 01). Conclusion Care bundles have proven to be effective in the fall prevention among inpatients in the Department of Neurology. It can reduce the Incidence of in-hospital falls and ensure patient safety during hospitalization (目的 探讨集束化护理干预策略在神经内科住院高危跌倒患者风险管理中的应用。方法 选取2023年1月—5月医院住院的高危跌倒患者260例随机分为对照组和观察组, 各130例。对照组实施防跌倒常规措施; 观察组在常规护理措施基础上, 基于文献阅读和访谈结果制定集束化护理方案。评估两组患者跌倒状态发生情况, 调查患者满意度。结果 观察组跌倒状态发生率13. 85%(18/130), 低于对照组的27. 69%(36/130), 差异有统计学意义(P＜0. 05)。观察组满意度评分高于对照组的, 差异有统计学意义(P＜0. 01)。结论 对神经内科住院患者实施集束化护理干预措施, 能有效降低患者跌倒状态发生率, 提高患者医疗安全。)

Introduction: Various approaches have been suggested to identify acute kidney injury (AKI) early and to initiate kidney-protective measures in patients at risk or with AKI. The objective of this study was to evaluate whether care bundles improve kidney outcomes in these patients. Methods: We conducted a systematic review of the literature to evaluate the clinical effectiveness of AKI care bundles with or without urinary biomarkers in the recognition and management of AKI. The main outcomes were major adverse kidney events (MAKEs) consisting of moderate-severe AKI, receipt of renal replacement therapy (RRT), and mortality. Results: Out of 7434 abstracts screened, 946 published studies were identified. Thirteen studies [five randomized controlled trials (RCTs) and eight non-RCTs] including 16,540 patients were eligible for inclusion in the meta-analysis. Meta-analysis showed a lower incidence of MAKE in the AKI care bundle group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.66–0.81] with differences in all 3 individual outcomes [moderate–severe AKI (OR 0.65, 95% CI 0.51–0.82), RRT (OR 0.63, 95% CI = 0.46–0.88) and mortality]. Subgroup analysis of the RCTs, all adopted biomarker-based approach, decreased the risk of MAKE (OR 0.55, 95% CI 0.41–0.74). Network meta-analysis could reveal that the incorporation of biomarkers in care bundles carried a significantly lower risk of MAKE when compared to care bundles without biomarkers (OR = 0.693, 95% CI = 0.50–0.96), while the usual care subgroup had a significantly higher risk (OR = 1.29, 95% CI = 1.09–1.52). Conclusion: Our meta-analysis demonstrated that care bundles decreased the risk of MAKE, moderate–severe AKI and need for RRT in AKI patients. Moreover, the inclusion of biomarkers in care bundles had a greater impact than care bundles without biomarkers. [ABSTRACT FROM AUTHOR]

Aims: To explore the implementation of a dementia care pathway in an acute care setting. Background: Dementia care in acute settings is often constrained by contextual factors. We developed an evidence‐based care pathway with intervention bundles, and implemented it on two trauma units, with the aim to empower staff and improve quality care. Design: Process evaluation using quantitative and qualitative methods. Methods: Pre‐implementation, unit staff completed a survey (n = 72) assessing family and dementia care skills and level of evidence‐based dementia care. Post‐implementation, champions (n = 7) completed the same survey, with additional questions on acceptability, appropriateness and feasibility, and participated in a focus group interview. Data were analysed using descriptive statistics and content analysis guided by the Consolidated Framework for Implementation Research (CFIR). Reporting Guideline: Standards for Reporting Qualitative Research Checklist. Results: Pre‐implementation, staff's perceived skills in family and dementia care were moderate overall, with high skills in 'building relationships' and 'sustaining personhood'. Evidence‐based interventions were delivered seldom to frequent, with 'individualized care' scoring lowest and 'assessing cognition' scoring highest. Implementation of the care pathway/intervention bundles was overshadowed by the pandemic, and failed due to major organisational‐ and process‐related barriers. Acceptability scored highest and feasibility lowest, with concerns relating to complexity and compatibility of pathways/bundles when introduced into clinical routines. Conclusions: Our study implies that organisational and process factors are the most influential determinants to the implementation of dementia care in acute settings. Future implementation efforts should draw on the evolving evidence within implementation science and dementia care research to ensure effective integration and improvement process. Relevance to Clinical Practice: Our study provides important learning around improving care for persons with dementia and their families in hospitals. Patient or Public Contribution: A family caregiver was involved in the development of the education and training programme. [ABSTRACT FROM AUTHOR]

Discharge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient's discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of care bundles on the prevention of incontinence-associated dermatitis (IAD)in the elderly. Methods Eighty critically ill elderly patients with diarrhea admitted to the Intensive Care Unit were selected and randomly divided into control group and study group, with 40 cases in each group. During the treatment, the control group received routine nursing, while the study group received care bundles. The incidence of IADs was compared between the two groups. Results The incidence of IAD in the study group was lower than that in the control group, with a significant difference(P

Despite effectiveness and accessibility of combined anti-retroviral therapy (cART), only 85% of people living with HIV (PLHIV) in the United States are virologically suppressed. Improving suppression is complex. Our objective was to consider unique factors in PLHIV with non-suppressed viral loads in clinic and improve the percentage of suppressed patients by implementing a "Suppression Bundle" consisting of three to five bundled interventions with the goal of improved suppression. Prior to the study, there were 567 HIV-positive patients receiving care in clinic. Of those, 89 had a measurable viral load (>40 copies/mL). In this pilot pre-post implementation, we focused on the 89 non-suppressed patients to (1) determine feasibility of implementing bundles and (2) increase the number of patients with suppressed viral loads pre- to post-intervention. Of non-suppressed patients, 65 were active in care immediately pre-intervention and participated in the pilot. At the completion of the 9-month intervention, 46 had viral loads <40 copies/mL, demonstrating substantial improvement with 70.1% of the previously non-suppressed patients achieving suppression. By considering unique patient factors, an individualized Suppression Bundle is acceptable, feasible, and may increase virally suppressed patients in an outpatient clinic. Next steps include determining whether suppression bundles can be implemented in differing practices. [ABSTRACT FROM AUTHOR]

This paper summarized the common types of nursing for patients with multiple myeloma with ostalgia, including care bundles, extended care, Traditional Chinese Medicine emotional care, mind-mapping based care, PRECEDE-PROCEED mode-based nursing. Application prospect, advantages and disadvantages of different type of nursing interventions were analyzed for providing basis of further research on nursing of multiple myeloma with ostalgia. (本研究总结多发性骨髓瘤骨痛患者临床常见护理模式, 包括集束化护理模式、延续性护理模式、中医情志护理模式、思维导图护理模式、格林护理模式, 并分析应用前景, 探讨利弊, 旨在为多发性骨髓瘤骨痛护理模式的深入研究及制定提供参考及借鉴。)

This article reviews the influencing factors of intraoperative pressure injury and the progress of preventive nursing. This paper provides reference and guidance to reduce the incidence of intraoperative pressure injury, improve patient comfort, reduce medical costs, and ensure patient nursing safety. (本文就术中压力性损伤发生的影响因素及预防护理进展进行了综述, 以期为降低术中压力性损伤的发生率、提高患者舒适度、降低医疗费用、保障患者护理安全提供参考和指导。)

This paper summarized the care bundles of Traditional Chinese Medicine (TCM) for a super-aged patient after interventional treatment for acute arterial embolization of lower extremity. Comprehensive TCM nursing interventions such as Chinese herbal medical oral care, acupoint massage, ear-tip bloodletting therapy; comprehensive auricular technique, Bian-stone and penetration of Chinese herbal medicine were carried out. TCM care bundles based on syndrome differentiation may reduce the incidence of complications and relieve the clinical symptoms of the patient. (本文总结1例超高龄急性下肢动脉栓塞患者术后集束化中医护理经验, 护理要点包括: 中药口腔护理、穴位按摩、耳尖刺络放血、耳穴综合操作技术、砭石熨摩中药透入法等。通过辨证施护, 有效降低并发症风险, 改善了患者症状, 舒适度和满意度明显提高。)

Objective To observe the value of PDCA cycle combined with care bundles for patients undergoing continuous renal replacement therapy (CRRT) for sepsis. Methods Totally 75 patients with sepsis requiring CRRT were divided into the control group (n=37) and the observation group (n=38) according to the sequential order of hospital admission. The control group received intensive care and infection control during the CRRT, and the observation group was given care bundles and infection control based on PDCA cycle management. The incidence of catheter-related blood stream infection(CRBSI), duration of CRRT and length of ICU stay were observed and compared between two groups. Results The incidence of CRBSI in the observation group was lower than that in the control group (P＜0. 05). The duration of CRRT and length of ICU stay were shorter in the observation group than those in the control group(P＜0. 05). Conclusion The PDCA cycle combined with care bundles may reduce the risk of CRBSI during the CRRT, which helps to promote successful withdrawal of CRRT and shorten the length of ICU stay. (目的 观察PDCA循环管理联合集束化护理策略在脓毒血症患者连续性肾脏替代治疗(CRRT)中的应用效果。方法 选取在2020年3月—2021年10月医院收治的75例行CRRT的脓毒血症患者为研究对象, 根据入院时间分为对照组37例和观察组38例。治疗期间, 对照组患者接受常规重症护理和感染预防措施, 观察组患者给予PDCA循环管理模式联合集束化护理策略。对比两组患者导管相关血流感染(CRBSI)发生率、CRRT治疗时间、ICU入住时间。结果 观察组CRBSI发生率低于对照组, 差异有统计学意义(P＜0. 05)。观察组患者CRRT诊疗时间和ICU入住时间较对照组短, 差异有统计学意义(P＜0. 05)。结论 PDCA循环管理模式联合集束化护理能降低脓毒血症患者CRRT治疗期间CRBSI发生风险, 有助于患者尽早撤机及缩短患者ICU住院时间。)

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of "Institute for Healthcare Improvement Ventilator Bundle", i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the "IHI Ventilator Bundle" combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle's compliance should be the gold standard combination. [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]

Objective: To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). Methods: Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011–2014 and 2015–2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. Results: The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). Conclusions: The use of PPH care bundles may be associated with lower resource use and fewer interventions. [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: During the COVID-19 pandemic, the Hillingdon Hospitals NHS Foundation Trust produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, insufficient education meant inconsistent adherence to this guidance. OBJECTIVE: To examine whether the implementation of a COVID-19 blood request panel improves adherence to local trust guidelines. METHOD: Between March and April 2020, initial blood investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic system that provided prompts for appropriate investigations. A re-audit between May and June 2020 was conducted to assess adherence post-intervention. RESULTS: 383 patients were identified in the initial audit cohort and a sample of 20 patients were re-audited. Adherence to Full Blood Count, Urea and Electrolytes, C-reactive Protein and Liver Function Tests increased to 100% from 99.7% (p = 0.8), 99.2% (p = 0.69), 98.7% (p = 0.61), and 96.6% (p = 0.4) respectively. Coagulation screen adherence increased to 90% from 72.8% (p = 0.09). Appropriate requesting of D dimers increased to 50% from 19.9% (p = 0.001). Inappropriate troponin requesting decreased to 26.3% from 38.9% (p = 0.23). CONCLUSION: A user-friendly COVID-19 panel of investigations resulted in improved adherence to guidelines. Clear communication and education are essential to help alleviate uncertainty during a pandemic. [ABSTRACT FROM AUTHOR]

Introduction: This patient safety and quality improvement report outlines the successful reduction of catheter-associated urinary tract infections (CAUTI) through a comprehensive interdisciplinary team approach. It emphasizes the implementation of best practices and the involvement of both patients and their families in catheter care. The project was conducted at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East, with 511 beds and over 20 inpatient units., Aim: The primary objective of this project was to assess gaps in current CAUTI prevention practices and implement effective strategies to reduce infection rates. By adopting quality improvement methodologies from the Institute of Healthcare Improvement (IHI) and the Deming Four-Stage Cycle, the aim was to prevent CAUTIs and improve patient safety and clinical outcomes., Method: Urinary catheters, commonly used for patients with neurogenic bladder dysfunction and sacral deep pressure injuries, posed a high risk of infection, with a daily infection risk of 3-7%. Despite available preventive measures, the facility experienced a high average CAUTI rate of 1.28/1000 catheter days from 2021 to mid-2023. This project involved the systematic identification of gaps, the adoption of evidence-based practices, and the engagement of healthcare staff, patients, and families in rigorous CAUTI prevention efforts., Result: The project resulted in a significant reduction in the CAUTI rate, decreasing from 1.28 infections per 1000 catheter days pre-intervention to 0.42 infections per 1000 catheter days post-intervention. This improvement highlights the effectiveness of collaborative efforts and evidence-based interventions in controlling and preventing CAUTIs., Conclusion: The findings of this project demonstrate that CAUTI prevention is achievable through a coordinated approach involving healthcare providers, strong evidence-based interventions, and the active participation of patients and families. This collaborative model led to better patient safety outcomes and significantly reduced CAUTI rates, showing the importance of comprehensive care strategies in mitigating preventable patient harm., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Plando et al.)

Objective To improve the treatment compliance of pediatric patients with type 1 diabetes mellitus and reduce the risk of skin-related complications by using a skin care bundles. Methods According to the sequence of hospital admission, 36 pediatric patients with type 1 diabetes mellitus were recruited as the control group, and another 36 pediatric patients were recruited as the study group. The control group received routine skin care during hospitalization, and the study group received a skin care bundles on the basis of routine skin management. The treatment compliance and incidence of skin problems related to insulin injection and fingerstick blood glucose monitoring were compared between two groups. Results The treatment compliance rate in the study group was higher than that in the control group(P＜0. 01). The incidences of skin problems skin problems related to insulin injection and fingerstick blood glucose monitoring in the study group were lower than those in the control group (P＜0. 01). Conclusion The skin care bundle is effective to improve the treatment compliance of pediatric patients with type 1 diabetes mellitus and reduce the risk of skin problems related to insulin injection. (目的 通过采用集束化干预策略提高1型糖尿病患儿皮肤管理的依从性, 降低皮肤问题的发生风险。方法 选择2019年1月-12月住院的36名1型糖尿病患儿作为对照组, 选取2020年1月-12月住院的36名1型糖尿病患儿作为试验组。对照组接受常规皮肤管理, 试验组在常规皮肤管理的基础上, 采用集束化管理策略。评估2组患儿皮肤管理的依从性, 记录胰岛素注射导致皮肤问题和指尖血糖监测相关皮肤问题的发生情况。结果 试验组皮肤管理的依从率高于对照组, 胰岛素注射导致皮肤问题和指尖血糖监测相关皮肤问题的发生率均低于对照组, 差异有统计学意义(P＜0. 01)。结论 集束化管理可以提高糖尿病患儿皮肤管理的依从率, 降低并发症的发生风险, 从而有利于提高照护者居家照护的质量。)

Objective: To evaluate the effectiveness of an educational intervention to improve the knowledge regarding ventilator-associated pneumonia (VAP) and practices of VAP prevention bundle among the intensive care unit (ICU) nurses in Salmaniya Medical Complex in Bahrain. Methods: A quasi- experimental study was conducted in the main ICU of Salmaniya Medical Complex in Bahrain from October 2021 to January 2022. A convenience sampling technique was used, and 58 ICU staff nurses were enrolled in the study. Tools used for data collection were a self-administered questionnaire to assess ICU nurses knowledge and an observational checklist to assess the adherence of ICU nurses to the VAP prevention bundle. Results: Of 58 total study subjects, almost three-quarters of the ICU nurses 42 (72%) had poor knowledge of VAP prior to the educational intervention. However, after the implementation, the proportion increased with 46 (79%) of the nurses acquiring good knowledge about the VAP and 56 (97%) of the ICU nurses acquiring good knowledge of the VAP prevention bundle. Overall, there was a significant improvement in the median score of adherences to the VAP prevention bundle elements before and after the intervention (p-value ≤ 0.05). Conclusion: This study concluded that the levels of knowledge about VAP and practices of the VAP prevention bundle can be improved by implementing a relevant educational program for ICU nurses. The findings of this study also provide evidence of the importance of a continuous training program for ICU nurses to ensure quality patient care in the critical care units.

Objective To investigate the bundled care on prevention of lower extremity deep venous thrombosis (DVT) in patients undergoing surgery for cerebral hemorrhage. Methods Totally 40 patients undergoing surgery for cerebral hemorrhage were randomly divided into the control group and observation group, with 20 cases in each group. The control group received routine care during the treatment period, and the observation group was given a bundled care program. The incidence lower extremity DVT was compared between two groups, and patient satisfaction with nursing service was evaluated. Results The incidence of lower extremity DVT in the observation group was lower than that in the control group(P＜0. 05). The satisfaction rate in the observation group was higher than that in the control group(P＜0. 05). Conclusion The bundled care program is potentially effective to reduce the risk of lower extremity DVT and improve the satisfaction of patients undergoing surgery for cerebral hemorrhage (目的 探讨集束化护理预防脑出血手术患者下肢深静脉血栓形成的效果。方法 40例脑出血手术患者随机分组对照组和观察组, 各20例。治疗期间, 对照组接受常规护理, 观察组实施集束化护理干预。对比两组患者下肢深静脉血栓形成的发生率, 评价患者对护理服务的满意度。结果 观察组下肢深静脉血栓形成的发生率低于对照组, 满意度高于对照组, 差异有统计学意义(P＜0. 05)。结论 集束化护理可以有效降低脑出血手术患者下肢深静脉血栓形成的发生风险, 提高患者满意度。)

Objective: To evaluate the effectiveness of an educational intervention to improve the knowledge regarding ventilator-associated pneumonia (VAP) and practices of VAP prevention bundle among the intensive care unit (ICU) nurses in Salmaniya Medical Complex in Bahrain. Methods: A quasi- experimental study was conducted in the main ICU of Salmaniya Medical Complex in Bahrain from October 2021 to January 2022. A convenience sampling technique was used, and 58 ICU staff nurses were enrolled in the study. Tools used for data collection were a self-administered questionnaire to assess ICU nurses knowledge and an observational checklist to assess the adherence of ICU nurses to the VAP prevention bundle. Results: Of 58 total study subjects, almost three-quarters of the ICU nurses 42 (72%) had poor knowledge of VAP prior to the educational intervention. However, after the implementation, the proportion increased with 46 (79%) of the nurses acquiring good knowledge about the VAP and 56 (97%) of the ICU nurses acquiring good knowledge of the VAP prevention bundle. Overall, there was a significant improvement in the median score of adherences to the VAP prevention bundle elements before and after the intervention (p-value = 0.05). Conclusion: This study concluded that the levels of knowledge about VAP and practices of the VAP prevention bundle can be improved by implementing a relevant educational program for ICU nurses. The findings of this study also provide evidence of the importance of a continuous training program for ICU nurses to ensure quality patient care in the critical care units. [ABSTRACT FROM AUTHOR]

Background: Although there is a rationale supporting that preoperative showering with 2% or 4% chlorhexidine gluconate (CHG) would decrease skin bacterial colonization, there is no consensus that this practice reduces the risk of surgical site infection (SSI). Objectives: Analyze the skin concentration of CHG after preoperative showering associated with the traditional skin preparation with CHG 4% for breast surgery. Methods: Randomized controlled trial that included 45 patients, all candidates for augmentation mammaplasty, allocated into three groups (A: no preoperative showering; B: one preoperative showering; C: two preoperative showering with CHG 4%) in a 1:1:1 ratio. Skin swabs collection was performed right before the surgical incision. The samples were, then, sent to spectrophotometry in order to determine the skin concentration of CHG at the beginning of surgery. Results: The age ranged from 18 to 61 years, with a mean of 37 years old. Group C had the lowest median concentration (0.057) followed by group B (0.060) and group A (0.072), however, with no statistical significance. The areola was the place with the lowest median concentration level (0.045), followed by the axilla (0.061) and the inframammary fold (IMF) (0.069). Still, when comparing the distribution of the sites, a statistically significant difference was found only between the axilla and the areola (p = 0.022). Conclusion: Preoperative showering with CHG 4% did not increase the concentration of this agent on the skin surface right before the surgical incision. Level of evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Central line-associated bloodstream infections are the most common and significant complications of central venous catheters. The development of central line-associated bloodstream infection in children is increasingly recognized worldwide, although it is often preventable. Guidelines recommend the application of a central catheter insertion bundle and appropriate catheter care to prevent central line-associated bloodstream infections. Central catheter insertion and maintenance care bundles consist of interventions that, when used together, are effective in preventing central lineassociated bloodstream infections. Recent literature on central line-associated bloodstream infection prevention shows that using a care bundle approach to improve central catheter insertion and maintenance practices reduces the rates of central line-associated bloodstream infections. Nurses have a direct and permanent role in the handling of central venous catheters. Therefore, they have a unique opportunity to contribute to the prevention of central line-associated bloodstream infections. However, prevention of central line-associated bloodstream infections is an important responsibility for nurses. The nurse’s knowledge of the evidence-based recommendations plays a key role in preventing catheter-related infections. This review summarizes recent literature regarding the prevention of central line-associated bloodstream infections in critically ill children.

Healthcare-associated infections (HAIs) and antimicrobial-resistant (AMR) infections are leading causes of neonatal morbidity and mortality, contributing to an extended hospital stay and increased healthcare costs. Although the burden and impact of HAI/AMR in resource-limited neonatal units are substantial, there are few HAI/AMR prevention studies in these settings. We reviewed the mechanism of action and evidence supporting HAI/AMR prevention interventions, including care bundles, for hospitalized neonates in low- and middle-income countries (LMIC).

Abstract Introduction Cirrhotic patients with septic shock have a poorer prognosis compared with the general population. Our study aimed to investigate the survival benefit of the implementation of hour-1 bundle proposed by Surviving Sepsis Campaign, and to analyze the predictors associated with short-term mortality of these patients. Methods A single-center, retrospective case-control study was conducted among adult patients who visited the emergency department between January 1, 2018 and December 31, 2019. All patients with a diagnosis of liver cirrhosis and septic shock were enrolled. Their baseline characteristics, laboratory results, source of sepsis, and sepsis bundle management were recorded. We further divided the patients into survivor and non-survivor groups to identify independent prognostic factors. Results A total of 88 patients were eligible for this study. The overall 30-day mortality rate was 53.4% (47/88). The proportion of hour-1 bundle achievement was 30.7% (27/88). There were no significant mortality differences between the hour-1 bundle achievement and non-achievement groups (44.4% vs. 57.4%, p = 0.35). Compared with the patients in the survivor group, patients in the non-survivor group had significantly more advanced stage of cirrhosis and a lower proportion of receiving source control (4.3% vs. 22.0%, p = 0.02). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score (adjusted hazard ratio [AHR] =1.52, p

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination.

Introduction Implementation of care bundles was shown to reduce the incidence of device-associated infections (DAIs). Substantial improvements in the rate of infection have been achieved by applying educational programs for infection control. Objectives: To demonstrate the impact of a comprehensive care bundle educational program (CCBEP) on DAIs, mortality rates in an emergency Intensive Care Unit (ICU), and improving healthcare workers (HCWs') knowledge, compliance to care bundle, and infection control practice. Methods A quasi-experimental study was carried out in an 15-beds emergency ICU, from May 2017 to October 2018. A comprehensive care bundle educational program was implemented. It covers items regarding device care bundle and infection control. Results Device care bundle compliance was variable between different bundle items. There was a significant improvement in HCWs' knowledge after the educational program intervention especially in hand hygiene, catheter-associated urinary tract infection (CAUTI) bundle, and total knowledge. There was a higher risk of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and CAUTI in the pre-intervention phase compared to post-intervention (RR: 1.4, 1.4, and 1.9 respectively). The total mortality rate decreased from 24.2/100 to 16.7/100 patients after intervention. Conclusions There was a statistically significant improvement in compliance with device care bundles with a decrease in the incidence of DAIs. [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 Background In the Quality in Acute Stroke Care (QASC) trial undertaken in stroke units (SUs) located in New South Wales (NSW), Australia (2005–2010), facilitated implementation of a nurse-led care bundle to manage fever, hyperglycaemia and swallowing (FeSS protocols) reduced death and disability for patients with stroke. We aimed to determine subsequent adherence to the bundled FeSS processes (reflective of the protocols) between 2013 and 2017 in Australian hospitals, and examine whether changes in adherence to these processes varied based on previous participation in the QASC trial or subsequent statewide scale-up (QASCIP—Quality in Acute Stroke Care Implementation Project) and presence of an SU. Methods Cross-sectional, observational study using self-reported organisational survey and retrospective clinical audit data from the National Acute Services Stroke Audit (2013, 2015, 2017). Mixed-effects logistic regression was performed with dependent variables: (1) composite outcome measure reflecting compliance with the FeSS protocols and (2) individual FeSS processes, including the year of audit as an independent variable, adjusted for correlation of outcomes within hospital. Separate models including interaction terms between the year of audit and previous participation in QASC/QASCIP and year of audit and SU were also generated. Results Hospital participation included the following: 2013—124 hospitals, 3741 cases; 2015—112 hospitals, 4087 cases; and 2017—117 hospitals, 4192 cases. An 80% increase in the odds of receiving the composite outcome in 2017 compared to 2013 was found (2013, 30%; 2017, 41%; OR 1.8; 95% CI 1.6, 2.0; p

Abstract Background Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. Methods A scoping review was carried out using the Arksey and O’Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. Results Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman’s rho = − 0.47, non-parallel cohort and − 0.65, prospective cohort studies), and between the complexity of elements and compliance (p

With the advent of the electronic medical record, automated alerts have allowed for improved recognition of patients with acute kidney injury (AKI). Pediatric patients have the opportunity to benefit from such alerts, as those with a diagnosis of AKI are at risk of developing long-term consequences including reduced renal function and hypertension. Despite extensive studies on the implementation of electronic alerts, their overall impact on clinical outcomes have been unclear. Understanding the results of these studies have helped define best practices in developing electronic alerts with the aim of improving their impact on patient care. As electronic alerts for AKI are applied to pediatric patients, identifying their strengths and limitations will allow for continued improvement in its use and efficacy.

Introduction: Cirrhotic patients with septic shock have a poorer prognosis compared with the general population. Our study aimed to investigate the survival benefit of the implementation of hour-1 bundle proposed by Surviving Sepsis Campaign, and to analyze the predictors associated with short-term mortality of these patients.Methods: A single-center, retrospective case-control study was conducted among adult patients who visited the emergency department between January 1, 2018 and December 31, 2019. All patients with a diagnosis of liver cirrhosis and septic shock were enrolled. Their baseline characteristics, laboratory results, source of sepsis, and sepsis bundle management were recorded. We further divided the patients into survivor and non-survivor groups to identify independent prognostic factors.Results: A total of 88 patients were eligible for this study. The overall 30-day mortality rate was 53.4% (47/88). The proportion of hour-1 bundle achievement was 30.7% (27/88). There were no significant mortality differences between the hour-1 bundle achievement and non-achievement groups (44.4% vs. 57.4%, p = 0.35). Compared with the patients in the survivor group, patients in the non-survivor group had significantly more advanced stage of cirrhosis and a lower proportion of receiving source control (4.3% vs. 22.0%, p = 0.02). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score (adjusted hazard ratio [AHR] =1.52, p < 0.01), serum lactate (AHR =1.03, p < 0.01), and source control (AHR =0.54, p = 0.02) were identified as independent prognostic factors in the multivariate regression model. Furthermore, the CLIF-SOFA score (area under curve [AUC]: 0.81) and lactate levels (AUC: 0.77) revealed good mortality discrimination ability in cirrhotic patients with septic shock.Conclusions: The application of the hour-1 bundle did not reveal a significant survival benefit to cirrhotic patients with septic shock. Clinicians could utilize CLIF-SOFA scores and lactate levels for mortality risk stratification and put more emphasis on the feasibility of source control to improve their prognosis. [ABSTRACT FROM AUTHOR]

Purpose Of Review: The landscape of post-partum hemorrhage management is rapidly changing. Modifications to definitions, bundles, and care plans occur frequently with management strategies becoming more complex. It has become apparent that the management of these patients requires a multidisciplinary approach with the involvement of obstetricians, anesthesiologists, gynecologist/oncologists, nursing, and care associates. This review article is meant to be an evidence-based review of post-partum hemorrhage with practical recommendations and a look at future directions of the management of post-partum hemorrhage from the vantage point of the obstetric anesthesiologist in an effort to enhance the collaborative treatment of this at risk population. [ABSTRACT FROM AUTHOR]

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Purpose: Intracerebral haemorrhage (ICH) is the most devastating form of stroke and a major cause of disability. Clinical trials of individual therapies have failed to definitively establish a specific beneficial treatment. However, clinical trials of introducing care bundles, with multiple therapies provided in parallel, appear to clearly reduce morbidity and mortality. Currently, not enough patients receive these interventions in the acute phase., Methods: We convened an expert group to discuss best practices in ICH and to develop recommendations for bundled care that can be delivered in all settings that treat acute ICH, with a focus on European healthcare systems., Findings: In this consensus paper, we argue for widespread implementation of formalised care bundles in ICH, including specific metrics for time to treatment and criteria for the consideration of neurosurgical therapy., Discussion: There is an extraordinary opportunity to improve clinical care and clinical outcomes in this devastating disease. Substantial evidence already exists for a range of therapies that can and should be implemented now., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: APJ was an independent member of the INTERACT3 trial steering committee and has received honoraria for advisory boards and speaking engagements from AstraZenenca. NPK has received speaker’s honoraria from AstraZeneca, and consulting with the National Football League. JNG has received research and consulting from AstraZeneca, CSL Behring, Octapharma, Takeda, NControl, Cayuga, and Prothya.CJMK is involved in the Netherlands Cardiovascular Research Initiative, which is supported by the Dutch Heart Foundation, CVON2015–01: CONTRAST, and the Brain Foundation Netherlands (HA2015·01·06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public- private partnerships (LSHM17016). This work was funded in part through unrestricted funding by Stryker, Medtronic and Cerenovus. The funding sources were not involved in study design, monitoring, data collection, statistical analyses, interpretation of results, or manuscript writing.; Radboud UMC and Erasmus MC received additional unrestricted funding on behalf of CONTRAST, for the execution of the Dutch ICH Surgery Trial pilot study and for the Dutch ICH Surgery Trial from Penumbra Inc. For the Dutch ICH Surgery Trial they also received a grant from ZonMw / Promising care (grant 80- 86200-08-25001). DT has received speaker’s honoraria and consulting from AstraZeneca. TS has received speaker’s honoraria and consulting from AstraZeneca, Bayer, Boehringer Ingelheim, BMS Pfizer, DaiichySankyo. All other authors of this paper have no conflicts of interest related to this review and nothing to disclose.