Paper I
Question
List four hospital acquired infections. Describe care bundle prevention for any one of them (2+4)
Answer
Four hospital-acquired infections (HAIs):
- Central Line-Associated Bloodstream Infection (CLABSI).
- Catheter-Associated Urinary Tract Infection (CAUTI).
- Ventilator-Associated Pneumonia (VAP).
- Surgical Site Infection (SSI).
Care bundle for prevention — CLABSI (Central Line Insertion/Maintenance Bundle)
A “care bundle” is a small set of evidence-based interventions that, when implemented together reliably, produce significantly better outcomes than when implemented individually.
Insertion bundle elements:
- Hand hygiene before catheter insertion.
- Maximal sterile barrier precautions during insertion — sterile gown, gloves, mask, cap for the operator, and a large sterile full-body drape for the patient.
- Chlorhexidine (>0.5% with alcohol) skin antisepsis at the insertion site, allowed to fully dry before puncture.
- Optimal catheter site selection — subclavian site preferred over femoral/internal jugular where feasible, to reduce infection risk (in adult patients).
- Use of a checklist during insertion, with authority given to any team member to stop the procedure if a breach in sterile technique is observed.
Maintenance bundle elements:
- Daily review of line necessity, with prompt removal as soon as the line is no longer clinically required — the single most important ongoing preventive measure.
- Aseptic technique for all line access (hub disinfection before each use — “scrub the hub”).
- Regular, appropriate dressing changes using sterile technique, with the site kept clean and dry.
- Daily inspection of the insertion site for signs of infection (redness, discharge, tenderness).
Effect: consistent, “all-or-none” bundle compliance (every element performed for every patient, every time) has been shown to markedly reduce CLABSI rates compared to inconsistent or partial adherence to individual measures.