From the Guidelines
Bundles of infection are evidence-based, standardized sets of practices that, when implemented together, significantly reduce the risk of healthcare-associated infections, particularly central line-associated bloodstream infections (CLABSIs), by targeting multiple infection pathways simultaneously. According to the most recent and highest quality study, implementing a bundle approach, including specific steps during both the insertion and maintenance of central lines, can decrease the rate of CRBSI by 66% 1.
Key Components of Infection Bundles
The bundle approach includes several key components, such as:
- Educating and designating only trained healthcare personnel
- Hand hygiene and the use of sterile gloves before catheter insertion
- The use of alcohol-containing chlorhexidine (CHG) for skin antisepsis before insertion and during dressing change
- Maximal sterile barrier precautions, including the use of a cap, mask, gown, and sterile full-body drape
- Avoiding the use of systemic antimicrobial prophylaxis
- Preferring an infraclavicular rather than a supraclavicular or groin exit site
Implementation and Effectiveness
For effective implementation, it is crucial to designate a multidisciplinary team, use checklists to ensure compliance, conduct regular audits, and provide feedback to staff 1. The synergistic effect of multiple interventions applied consistently produces better outcomes than individual measures alone, as each element reinforces the others to break the chain of infection transmission.
Reducing Infection Rates
By implementing these bundles, healthcare settings can significantly reduce infection rates, particularly CLABSIs, which are a major concern in oncological populations, with an estimated rate of 2.5 per 1000 catheter-days 1. The average cost per episode of CRBSI is $45,814, making CRBSI one of the costliest healthcare-associated infections, highlighting the importance of implementing effective prevention strategies 1.
From the Research
Definition of Bundles of Infection
Bundles of infection refer to a set of evidence-based interventions used to prevent health care-associated infections (HAIs) [(2,3,4,5)]. These bundles are designed to address specific types of HAIs, such as central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections.
Components of Bundles
The components of bundles may vary depending on the specific type of HAI being targeted. However, some common elements include:
- Hand hygiene practices [(4,6)]
- Use of sterile equipment and supplies [(2,3)]
- Proper insertion and maintenance of invasive devices [(2,5)]
- Surveillance and monitoring of infection rates [(2,3)]
- Education and training of healthcare workers [(4,6)]
Effectiveness of Bundles
Studies have shown that bundles can be effective in reducing the rates of HAIs in various healthcare settings, including intensive care units [(2,3,5)]. For example, a study found that the implementation of central line bundles and ventilator bundles in pediatric intensive care units resulted in a significant decrease in the rates of central line-associated bloodstream infections and ventilator-associated pneumonia 5.
Challenges and Limitations
Despite the effectiveness of bundles, there are challenges and limitations to their implementation, including: