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Background & Problems: Pressure ulcers are tissue defects that form on the skin as a result of progressive skin damage. Pressure ulcers are a skin-integrity-related care issue and an important clinical indicator of care quality, especially for lung cancer inpatients who face rapidly deteriorating health conditions due to multiple symptoms and the side effects of treatment. Treating severe pressure ulcers may consume considerable manpower, time, and medical resources. Pressure ulcers may be avoided or effectively treated when nurses conduct proper skin assessments and care for wounds properly. Purpose: This project evaluates the efficacy of skin care bundles in terms of reducing the incidence density of pressure ulcers in lung cancer inpatients. Resolution: Data gathered between January 2010 and March 2011 showed unstable incidence density for pressure ulcers. The average pressure-ulcer incidence density in lung cancer inpatients was 2.09%, which was 8-times higher than the average for all patients. Using evidence-based care bundles for pressure ulcer prevention, we trained nurse staffs to incorporate these bundles into their clinical daily care of lung cancer patients in our hospital. Results: During the study period between November 2011 and January 2012, the pressure-ulcer incidence density gradually fell to 0.55%. The incidence density continued to fall to 0.33% over the subsequent 8 months. Conclusions: We used the concept of "care bundles" to establish a standard skin-care protocol for advanced lung cancer inpatients. This protocol improved the clinical ability of nursing staffs and effectively maintained skin care quality in lung cancer patients. [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.

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]

Central line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonia (VAP) are common problems in adult, pediatric (PICU) and neonatal (NICU) intensive care unit patients. Care bundles have been developed to prevent these hospital-acquired infections and to provide best possible care. Studies in adults have proven that care bundles contribute to a decrease in CLABSI and VAP rates. The purpose of this literature review was to critically appraise the known evidence of the effectiveness of central line bundles and ventilator bundles in PICU and NICU patients. The number of publications of central line bundles and ventilator bundles in PICU and NICU patients is limited compared to adults. Ten studies in PICU patients demonstrated a significant decrease in the CLABSI or VAP rate after implementation of the bundle. Two studies in neonates demonstrated a reduction in the CLABSI rate after implementation of the central line bundle. No studies on the effectiveness of the ventilator bundle in neonates were found. Bundle elements differed between studies, and their scientific basis was not as robust as in adults. Monitoring of compliance to bundle elements seems required for optimal reduction of CLABSI and VAP. Bundle components that focus on maintenance of a central line probably are important to prevent CLABSI in children. [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]

Reduction of hospital-acquired pressure ulcers is a patient and nursing priority. Although evidence-based interventions to prevent such ulcers are well known, reducing this healthcare burden has proven consistently difficult. Via case studies, this article describes how a bundle approach to pressure ulcer prevention may be adapted for use within different clinical areas. It illustrates how collaborative learning may facilitate the spread of improvement work across a health board and build improvement skills within nursing. [ABSTRACT FROM AUTHOR]

Implementation of care bundles for prevention of ventilator-associated pneumonia (VAP) and its impact on patient outcomes requires validation with long-term follow-up. A collaborative multi-centre cohort study was conducted in five Spanish adult intensive-care units. A care bundle approach based on five measures was implemented after a 3-month baseline period, and compliance, VAP rates, intensive-care unit length of stay (ICU LOS) and duration of mechanical ventilation were prospectively recorded for 16 months. There were 149 patients in the baseline period and 885 after the intervention. Compliance with all measures after intervention was <30% (264/885). In spite of this, VAP incidence decreased from 15.5% (23/149) to 11.7% (104/885), after the intervention (p <0.05). This reduction was significantly associated with hand hygiene (OR = 0.35), intra-cuff pressure control (OR = 0.21), oral hygiene (OR = 0.23) and sedation control (OR = 0.51). Use of the care bundle was associated with an incidence risk ratio of VAP of 0.78 (95% CI 0.15-0.99). We documented a reduction of median ICU LOS (from 10 to 6 days) and duration of mechanical ventilation (from 8 to 4 days) for patients with full bundle compliance (intervention period). Efforts on VAP prevention and outcome improvement should focus on achieving higher compliance in hand and oral hygiene, sedation protocols and intracuff pressure control. [ABSTRACT FROM AUTHOR]

Two cases of nasal skin necrosis secondary to pressure from the use of continuous positive airway pressure (CPAP) face masks are presented. Both developed skin necrosis as a result of wearing these masks over the nasal bridge. These cases highlight the need for clinical vigilance in application of CPAP masks, the need for monitoring the skin of the nose during CPAP use and the possible need for modifications in design to help prevent this serious complication. [ABSTRACT FROM AUTHOR]

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)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dramowski, Aucamp, Beales, Bekker, Cotton, Fitzgerald, Labi, Russell, Strysko, Whitelaw and Coffin.)

Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, once high reliability is achieved in a hospital unit, it must be maintained to avoid process deterioration. This case study examines an intervention to implement care bundles (a collection of evidence-based practices) in four hospitals to achieve standardized care in perinatal units. The results show different patterns in the rate and magnitude of change within the hospitals to achieve high reliability. The study is part of a larger nationwide study of 16 hospitals to improve perinatal safety. Based on the findings, we discuss the role of leadership for implementing and sustaining high reliability to ensure freedom from unintended injury. [ABSTRACT FROM AUTHOR]

An increasing incidence of StaphyIococcus aureus bacteraemia was identified by Stirling Royal Infirmary neonatal intensive care unit (NICLJ). In order to work towards the Scottish Patient Safety Programme (SPSP) targets, current policies regarding obtaining blood cultures or siting intravenous catheters were reviewed and changes implemented. Hand hygiene for staff and parents was further promoted. This culminated in the NICLJ reaching the SPSP targets with on-going success. [ABSTRACT FROM AUTHOR]

The article discusses a study which aimed to determine the association of dressing disruption on the risk for development of catheter-related blood-stream infection. Results show that dressing disruption occurred more frequently in patients with higher Sequential Organ Failure Assessment scores and those receiving renal replacement. The study concluded that catheter dressing disruption is a risk factor for catheter- related infections.

The article presents a study on the effects of implementing a bundle of care on ventilator-associated pneumonia (VAP) patients. The researchers used a before-and-after structure to analyze the effects of implementing a VAP prevention bundle. The elements of the bundle include subglottic secretion drainage and chlorhexidine mouth care. They found that the bundle of care using the Institute for Healthcare Improvement (IHI) approach was connected with a sustained reduction in VAP incidence.

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]

One recent approach to facilitating guideline implementation involves the use of care bundles. This document presents a care bundle package addressing VAP prevention in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalised methodology to assess the supporting data, based on multi-criteria decision analysis. The resulting VAP care bundles for prevention were: non-ventilatory circuit changes unless specifically indicated, alcohol hand hygiene, appropriately educated and trained staff, incorporation of sedation control and weaning protocols into patient care, and oral care with clorhexidine. Adoption of these care bundles should rationalise VAP prevention practises and improve outcomes, such as length of stay. [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]

Background: Ventilator-associated pneumonia (VAP), in addition to causing distress to patients, is associated with increased length of stay in intensive care, higher rates of morbidity and mortality and pressure on critical care capacity and costs. A care bundle approach for the management of ventilated patients can reduce the risk of VAP. Aim: This paper aims to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of VAP, within an adult intensive care unit of a district general hospital. Intervention: Subsequent to the implementation of care bundle components, evidence from audit data revealed that compliance fell below standard. To address this, Department of Health staff who were visiting the hospital recommended that the frequency of audit activity should be increased to facilitate the rapid identification of areas of poor compliance, which could then be rectified. Conclusion/Implications: Daily care bundle audits showed a positive impact on compliance. However, without a robust method to collect data on prevalence of VAP, the impact of the care bundles on improving outcomes for this aspect of care is unknown. [ABSTRACT FROM AUTHOR]

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]

Introduction: There is only moderate adherence to evidence-based practice in critical care. Care bundles can be used to increase adherence to best clinical practice. Components of bundle interventions, bundle implementation rates, barriers and facilitators of bundle implementation, and the effect of care bundles on short-term patient outcomes such as intensive care unit (ICU) mortality all appear to be regularly studied. However, over the last years, critical care research has turned towards long-term patient-relevant outcomes after discharge from the ICU. To our knowledge, there is no systematic overview on the long-term effect of care bundle implementation on patient-relevant outcomes. We present a protocol for a scoping review of the available literature on the effect of the implementation of care bundles in the ICU on long-term patient-relevant outcomes., Methods and Analysis: This scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O'Malley framework. The recommendations of the Joanna Briggs Institute for Scoping Reviews will also be followed. A systematic literature research will be performed using electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CDSR and CENTRAL). A preliminary search has been conducted on 1 September 2021, yielding 1929 entries. The main search, data extraction and charting has not been started yet. This scoping review will provide an overview of the long-term patient-relevant outcomes that have been used to assess the implementation of care bundles in the ICU. It will be the first study to summarise the long-term impact of care bundles for critically ill patients and identify research gaps to inform future research., Ethics and Dissemination: Due to the utilisation of already published primary studies, ethical approval is dispensable. Results of this work will be published in a peer-reviewed journal., Competing Interests: Competing interests: NP, A-CK, ERB and MN have no conflicts of interest to declare. BW received personal fees for consultancy and speaking from ORION Pharma, outside the submitted work. CS reports grants from Deutsche Forschungsgemeinschaft/German Research Society, during the conduct of the study; grants from Drägerwerk AG & Co. KGaA, grants from Deutsche Forschungsgemeinschaft / German Research Society, grants from Deutsches Zentrum für Luft- und Raumfahrt e.V. (DLR)/German Aerospace Center, grants from Einstein Stiftung Berlin/Einstein Foundation Berlin, grants from Gemeinsamer Bundesausschuss/Federal Joint Committee (G-BA), grants from Inneruniversitäre Forschungsförderung/Inner University Grants, grants from Projektträger im DLR/Project Management Agency, grants from Stifterverband/Non-Profit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from Baxter Deutschland, grants from Cytosorbents Europe GmbH, grants from Edwards Lifesciences Germany, grants from Fresenius Medical Care, grants from Grünenthal GmbH, grants from Masimo Europe, grants from Pfizer Pharma PFE, personal fees from Georg Thieme Verlag, grants from Dr. F. Köhler Chemie, grants from Sintetica GmbH, grants from Stifterverband für die deutsche Wissenschaft e.V./Philips grants from Stiftung Charité, grants from AGUETTANT Deutschland, grants from AbbVie Deutschland. KG, grants from Amomed Pharma GmbH, grants from InTouch Health, grants from Copra System GmbH, grants from Correvio, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften e.V., grants from Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin (DGAI, grants from Stifterverband für die deutsche Wissenschaft e.V./Metronic, grants from Philips ElectronicsNederland BV, grants from BMG, grants from BMBF, grants from BMBF, grants from Deutsche Forschungsgemeinschaft/German Research Society, outside the submitted work; in addition, CS has a patent 10 2014 215 211.9 licensed, a patent 10 2018 114 364.8 licensed, a patent 10 2018 110 275.5 licensed, a patent 50 2015 010 534.8 licensed, a patent 50 2015 010 347.7 licensed and a patent 10 2014 215 212.7 licensed., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements)., Methods: Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively., Findings: 3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection , (3) Case management , and Implementation (3 + I ) . The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection . A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control., Interpretation: The 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.g., self-inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a major gap., Funding: This work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the "la Caixa" Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government)., Competing Interests: We declare no competing interests., (© 2021 The Authors.)

Abstract Background Intravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability. Methods We studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame. Results 47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems. Conclusions Overall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery.

Abstract Resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Microorganisms such as Escherichia coli and Klebsiella pneumoniae, which are commensals and pathogens for humans and animals, have become increasingly resistant to third-generation cephalosporins. Moreover, in certain countries, they are also resistant to carbapenems and therefore susceptible only to tigecycline and colistin. Resistance is primarily attributed to the production of beta-lactamase genes located on mobile genetic elements, which facilitate their transfer between different species. In some rare cases, Gram-negative rods are resistant to virtually all known antibiotics. The causes are numerous, but the role of the overuse of antibiotics in both humans and animals is essential, as well as the transmission of these bacteria in both the hospital and the community, notably via the food chain, contaminated hands, and between animals and humans. In addition, there are very few new antibiotics in the pipeline, particularly for Gram-negative bacilli. The situation is slightly better for Gram-positive cocci as some potent and novel antibiotics have been made available in recent years. A strong and coordinated international programme is urgently needed. To meet this challenge, 70 internationally recognized experts met for a two-day meeting in June 2011 in Annecy (France) and endorsed a global call to action ("The Pensières Antibiotic Resistance Call to Action"). Bundles of measures that must be implemented simultaneously and worldwide are presented in this document. In particular, antibiotics, which represent a treasure for humanity, must be protected and considered as a special class of drugs.

Central line associated bloodstream infection (CLABSI) reduction programmes in hospitalised children have been focused in the intensive care setting and little data is available on the efficacy and cost effectiveness of such programmes In other clinical areas. Prospective monitoring of hospital acquired CLABSI rates in all clinical areas was performed at Alder Hey Children's Hospital for a period of three years following the implementation of a central venous line (CVL) care bundle. We observed a decrease in CLABSI rates from 220 in the first year following intervention to 108 per 100,000 patient days (p=0.002) in the third year of the study, demonstrating a decrease of over 50% in CLABSI rates. Blood culture contamination rates were also significantly reduced. The introduction of a CVL care bundle produced a significant, sustainable reduction in hospital acquired CLABSI rates in a children's hospital setting. [ABSTRACT FROM AUTHOR]

Purpose: To explore the clinical evidence available on mindful organizing (MO) that will improve teamwork for positioning and managing central venous catheters in patients admitted to neonatal intensive care and other pediatric intensive care units to decrease central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI)., Methods: We searched several databases (PubMed, Embase, CINAHL, CENTRAL, SCOPUS, and Web of Science) up to June 2018. We included studies investigating the effectiveness of MO teamwork in reducing CLABSI and CRBSI. The systematic review followed the PRISMA guidelines. We used validated appraisal checklists to assess quality., Results: Seven studies were included: only one was a non-randomized case-controlled trial (CCT). All the others had a pre-post intervention design, one a time-series design and one an interrupted time-series design. The methodological heterogeneity precluded a meta-analysis. Despite the low certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, three studies including thousands of participants provided numerical data for calculating risk ratios (RR) and 95% confidence intervals (CI) comparing MO with no intervention for decreasing the CLABSI rate in neonatal and pediatric ICUs. The one CCT disclosed no significant difference in the CLABSI rate decrease between groups (RR = 0.96; 95%CI 0.47-1.97). Nor did the pre- and post-intervention interrupted time-series design disclose a significant decrease (RR = 0.80; 95%CI 0.36 1.77). In the study using a before-after study design, the GRADE system found that the CLABSI rate decrease differed significantly in favor of post-intervention (RR = 0.13; 95%CI 0.03 0.57; p  = 0.007)., Conclusions: Despite the decreased CLABSI rate, the available evidence is low in quality. To reduce the unduly high CLABSI rates in neonatal and pediatric intensive care settings, custom-designed clinical trials should further define the clinical efficacy of MO to include it in care bundles as a new international standard.

Objective: This study was designed to determine the effects of care bundles on patients with severe pneumonia complicated with respiratory failure and to discuss the adverse reaction rate in prognosis., Methods: A total of 64 patients with both severe pneumonia and respiratory failure admitted to the intensive care unit (ICU) of our hospital from January 2019 to December 2020 were enrolled as research objects. These patients were equally divided into a control group and an experimental group in a random manner. The experimental group was given care bundles, while the control group was given conventional nursing. Then the nursing effect, adverse reactions, and nursing satisfaction of the two groups were compared and analyzed., Results: The experimental group experienced shorter mechanical ventilation time and hospital stay than the control group. After nursing, both groups got apparent improvements on the levels of partial pressure of carbon dioxide (PaCO 2 ), partial pressure of oxygen (PaO 2 ), and oxygen saturation, with better improvements in the experimental group than those in the control group. In terms of the incidence of ventilator-associated pneumonia (VAP), chest ultrasound imaging, and nursing satisfaction, the experimental group garnered more positive results than the control group (all P<0.05)., Conclusions: Care bundles can greatly improve the nursing effect on patients with severe pneumonia complicated with respiratory failure. Compared with conventional nursing, it can contribute to considerably shorter mechanical ventilation time and hospital stay, optimal blood gas indexes and oxygen saturation, substantially lower incidence of ventilator-related diseases, and better prognostic recovery effect., Competing Interests: None., (AJTR Copyright © 2021.)

Central line associated bacteraeimia (CLAB) results in significant patient morbidity, mortality and cost to the New Zealand healthcare system. The introduction of a national programme to reduce the incidence of CLAB in New Zealand hospitals is outlined. [ABSTRACT FROM AUTHOR]

Pressure injuries are potentially preventable but frequently occurring adverse events. Intensive care patients have major risk factors for pressure injury with a reported pressure injury prevalence of 12–33%. Multi-faceted interventions, also known as programs or care bundles, are recommended to prevent pressure injuries. This systematic review evaluated the effectiveness of pressure injury prevention programs in reducing pressure injury prevalence and incidence in the adult intensive care population. It also critically appraised the program components and strategies used to implement these programs. We searched PubMed, EMBASE (embase.com), Ovid MEDLINE, EBSCOhost CINAHL, and Cochrane Library databases separately for papers published in English and Chinese from the year of 2000 to May 2018. After removing duplicates, two authors independently screened the title and abstracts, then full-text against the inclusion and exclusion criteria. Data was extracted by one author and checked by a second author. Quality appraisal was conducted by two authors by using the Quality Improvement Minimum Quality Criteria Set, and the Mixed Methods Appraisal Tool. Content analysis was used to categorise program components. Implementation strategies were grouped into six classifications: dissemination strategies, implementation process strategies, integration strategies, capacity building strategies, sustainability strategies, and scale up strategies. Twenty-one peer reviewed papers (12 quality improvement projects, and 9 research papers from 8 studies) were included. Pressure injury prevention programs with 2–11 components were commonly implemented. Common components of the programs included: clarification of staff roles, introducing new roles, repositioning, staff and patient education, support surfaces use, pressure injury risk assessment, skin assessment, nutrition needs assessment, documentation, multidisciplinary team involvement, and mobilisation. Implementation strategies commonly used were education, audit and feedback, and standardising documentation. Five of the eight research studies and one of the quality improvement projects reported significant decrease in pressure injury prevalence, and/or increase in compliance to pressure injury prevention protocols and strategies. Two quality improvement papers reported cost savings of $1 million and £2.6 million respectively after the implementation of the programs. Much of the work on multicomponent pressure injury prevention programs has been undertaken as quality improvement projects and before and after research studies with limited rigour. However, positive outcomes and strong theoretical rationales for the components in the programs suggest that they are beneficial. This calls for future high-quality research such as randomised controlled trials to test the effectiveness of multicomponent interventions and their implementation strategies. Tweetable abstract : Some multicomponent pressure injury prevention programs were found to be effective; however, higher level of research evidence is needed. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effect of care bundles on the postoperative pain, negative emotions, and self-care ability of patients with acute dacryocystitis., Methods: We recruited 103 patients with acute dacryocystitis undergoing surgery in our hospital from July 2018 to October 2019 in this study. Among them, 55 patients received care bundles (the research group, RG) and the other 48 received conventional care (the control group, CG). The two groups were compared in response rate, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Exercise of Self-Care Agency Scale (ESCA) before and after nursing interventions, as well as postoperative Visual Analogue Scale (VAS), MOS 36-item short-form health survey (SF-36), and patient satisfaction rate., Results: After the care, the RG had a markedly higher response rate than the CG. No significant differences were found in SAS and SDS scores between the two groups before nursing care, and lower scores were found in the RG after the care. There was no significant difference in VAS scores before nursing care, and the RG showed higher scores than the CG after the care. There was no significant difference in self-care skills, self-care responsibility, self-concept, health knowledge, and self-care ability between the two groups before nursing care, but they all increased after the care. Markedly higher scores of SF-36 and a higher patient satisfaction rate were observed in the RG after the care., Conclusion: Care bundles can enhance the self-care ability of patients with acute dacryocystitis after surgery, reduce pain intensity, relieve negative emotions, improve quality of life, and increase patient satisfaction with nursing care., Competing Interests: None., (AJTR Copyright © 2021.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nguyen and Menon.)

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]

Objective: To investigate the effects of care bundles for patients with pressure ulcers and the impact on self-care efficacy., Method: A total of 160 patients with pressure ulcers were enrolled and divided into two groups using a lottery method. The control group (n=80) was cared for with routine nursing while the observation group (n=80) was additionally nursed with care bundles for 3 months. Both groups were compared in terms of grading of pressure ulcers, self-care efficacy, pressure ulcer management, awareness rate, and quality of life., Results: At 3 months after nursing, the grading of pressure ulcers was significantly improved in both groups. The observation group exhibited higher incidence of pressure ulcers, unstageable and deep tissue injury than the control group ( P <0.05). DSES scores were improved in both groups ( P <0.05). Scores of daily living, health behavior, compliance behavior, and emotional management in the observation group were higher than those in the control group ( P <0.05). The skills of pressure ulcer management were strengthened in both groups ( P <0.05). Scores of nutritional support, repositioning, skin care, dressing changes, and pressure ulcer assessment in the observation group were higher than those in the control group ( P <0.05). The observation group also exhibited higher scores in terms of diet, pressure ulcer monitoring, lesion staging, complications and knowledge of pressure ulcer triggers than the control group ( P <0.05). Quality of life was significantly improved in both groups after 3 months of nursing. PH, RP, BP, GH, VT, SF, RE and MH scores in the observation group were higher than those in the control group ( P <0.05)., Conclusion: Care bundles can improve pressure ulcer grading, enhance patient self-care efficacy and skills of pressure ulcer management, and help improve patient awareness rates and quality of life for patients with pressure ulcers, which is worth of promoting., Competing Interests: None., (AJTR Copyright © 2021.)

This integrative review presents the most recent and relevant critical care nursing research publications in the United States. A comprehensive search identified publications on the topics of delirium; early mobility; communication; palliative care; tele-intensive care unit; care bundle implementation; and prevention, detection, and early management of infection. The evidence is summarized for each of these topics, as well as other research, with suggestions and guidance for end users., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)