Bundle care approach

A bundle is a set of evidence-based practices that, when performed collectively and reliably, improve patient outcomes. Individual elements of bundles are well-established practices, combined in a structured protocol, Whole clinical team agrees to it and is responsible for the same, For Example for IV line handling, the local healthcare team selects a set of 5 evidence based interventions to make a bundle, which may be named IV line bundle and strives to implement it consistently and reliably, Structured ‘care bundle’ approach has been designed to help healthcare workers consistently deliver the safest possible care for patients undergoing treatments.
In this webinar we will learn how to– Characteristics of bundle care approach, how it can be put into practice
Let us assume we have to make a bundle for minimising the risk of infection related to the use of invasive procedure. So the clinical team go in following sequence, Note and record various steps required for the procedure, There may be one or more ways to perform each individual step, Search the evidence, and select the ‘best’ way to perform each step, Identify 3-5 critical steps amongst the list of all above steps, Select evidence based intervention for these 3-5 steps, These interventions will be called as “bundle” for that particular procedure.
To prevent peripheral intravascular cannula associated infections, the bundle care recommendations may include, Daily review if the line is necessary. Promptly removeif unnecessary and documentation, Strict Hand hygiene measures before line handling, Handling of injection ports- All injection ports or hubs are cleaned with antiseptic solutions before each use.Clean the hub of IV cannula with alcohol, chlorhexidine/alcohol, povidone-iodine solution, Use of aseptic non-touch technique during procedures. E.g. if the intention is to give IV injection, keep injection tip covered with needle in a sterile tray and avoid its contact with any other place. After procedure, close the port and clean the hub again by antiseptics. Change the dressing if it is wet, soiled, loose.
Providing education and communication to unit staff regarding bundle care components, Conducting audits to assess compliance with bundle care components, Regularly reporting the results back to unit staff, Team approach to develop and implement bundle interventions. Teams can be created from the pool of health care professional e.g. doctors and nurses; and the guidance can be taken from the other departments e.g microbiology, infection control committee etc.
To summarise, in this webinar we have learnt about- Bundle care approach can be an effective way of infection prevention, Careful selection of strategies of bundle care for a focused intervention is the backbone, Implement 3-5 evidence based interventions for a focused intervention, Integrate team approach, auditing and regular reporting of results . Thank you
  • Introduction...
  • 1. Background...
  • 2. Learning object...
  • 3. Elements of bun...
  • 4. Bundle care for...
  • 5. Example of iden...
  • 6. Example of iden...
  • 7. Strategies for ...
  • 8. Summary...
 

Introduction

DR. SHIV SAJAN SAINI
MD, DM (Neonatology)

Assistant Professor
Department of Pediatrics
PGIMER, Chandigarh

1. Background

â–º Bundle care - set of evidence - based practices
      ♦ Expected to improve patient outcomes

â–º Individual elements of bundles
      ♦ Well established practices - protocolised

â–º Whole team agrees to the bundle care
      ♦ Implement collectively and reliably

â–º Example
      ♦ Care bundle to reduce PIVC related BSI

2. Learning objectives

â–º What are the elements of bundle care approach?

â–º How it can be put into practice?

3. Elements of bundle care approach

â–º No of interventions in a bundle
      ♦ Range usually 3 to 5

â–º Milestones of making care bundles
      ♦ Identification of key steps of the procedure
      ♦ Identification of key interventions related to these steps

â–º Interventions related to these critical steps noted
      ♦ 3-5 key interventions identified
      ♦ Evidence based - high quality

â–º This group of interventions - care bundle
      ♦ Implemented together

4. Bundle care for PIVC related infections

â–º Step 1 - Enumeration of steps related to placement of PIVC

â–º Step 2 - Identification of 3 to 5 most important steps
      ♦ Critical for prevention of BSI related to PIVC insertion
         and maintenance

â–º Step 3 - Identification of best evidence-based interventions
                  for steps

5. Example of identification of critical steps

â–º Duration of PIVC

â–º Lapses during the procedure of PIVC insertion

â–º Lapses during handling intravenous lines during day-to-day
    nursing care

â–º Repeated puncturing of antibiotic vials/ saline ampoules

6. Example of identification of interventions

â–º Daily documentation of the necessity of PIVC

â–º ANTT while PIVC insertion

â–º Injection ports or hubs to be cleaned with antiseptic
    swabs before each use

â–º Avoidance of repeated punctures of drug vials/ IV fluid
    ampoules

7. Strategies for promoting bundle care

â–º Education and improve communication amongst the unit staff
      ♦ Teams from the pool of healthcare professionals

â–º Periodically check for compliance and efficacy
      ♦ Audit

â–º Appraisal of the unit staff
      ♦ Reinforcement

8. Summary

â–º An attractive way of infection prevention

â–º Careful selection of strategies for a focused intervention

â–º 3-5 evidence based interventions implemented together

â–º Team approach, auditing and regular reporting of results