Prevention of Healthcare Associated Infections - Bundled Approach

Abstract 1
Prevention of Healthcare associated infections – Bundled approach
Healthcare associated infections (HCAI) are one of the major global health problems causing
increased morbidity and mortality. Antimicrobial resistance is further adding to this disease burden
and the focus is increasingly shifting towards prevention of these infections which are also now
considered to be a kind of preventable error.
Amongst many evidence-based interventions proposed to address these HCAI, care bundle is a
unique and novel concept first proposed by Institute of healthcare improvement (IHI). It involves
grouping together of key elements of care for procedure to provide a systematic method to improve
and monitor the delivery of clinical care processes. They aim to ensure that all patients consistently
receive the best care treatment, all the time. The care bundles consist of 3-5 set of evidence-based
elements that need to be performed collectively rather than singularly for a successful outcome. This
approach has been successfully applied to device associated infections like VAP, CLABSI, CAUTI SSI,
antimicrobial stewardship and management of multidrug resistant organisms and have been reliably
shown to improve patient outcomes.
Preventive bundle typically exemplifies a multidisciplinary approach and are multimodal in nature.
The implementation of bundle requires planning in terms of understanding the problems, baseline
assessment of existing practices and challenges, goal setting, audits, education, skilling, resource
management & feedback to the stakeholders regarding relevant clinical and prevention strategies.
Bundles thus help the care givers translate evidence into practice in a simplified and measurable
manner. They foster teamwork, ownership, accountability and a culture of safety amongst care
givers.
Abstract 2
Barrier Nursing, Reverse Barrier Nursing & Isolation Practices
Hospitals are not safe places as there is an increase in risk of transmission of infections from one
person to another due to proximity of patients and multiple healthcare workers involved in
providing care. Barrier nursing is an archaic term for a set of stringent infection control techniques
used in nursing to protect medical staff against infection by patients and also protect patients with
highly infectious diseases from spreading their pathogens to other non-infected people.
One of the essential components of preventing the transmission of infections is the adherence of
isolation precautions that are composed of two tiers: standard precautions and transmission based
precautions. The latter are special precautionary measures, practices, and procedures used in the
care of patients with documented or suspected infection/colonization of highly transmissible or
epidemiologically important pathogens. The measures include isolation of patients along with
standard precautions like appropriate use of hand hygiene, personal protective equipment, patient
transportation, linen and waste management.
Major indications for transmission include micro-organisms with antibiotic resistance – MRSA, VRE,
MDRO or micro-organism with high transmission- C diff, Mycobacterium tuberculosis, norovirus,
influenza or micro-organisms with high virulence- SARS, Ebola. These micro-organisms have different
modes of transmission. For example, MRSA, VRE or C difficile get transmitted through contact, while
Mycobacterium tuberculosis and influenza have airborne and droplet modes of transmission
respectively.
Transmission based precautions are designed to address these pathogens with specific modes of
spread and combine the isolation practices with good nursing infection prevention techniques
popularly referred to as barrier techniques to minimise the risk of transmission. They should be
empirically implemented once the patients present with signs and symptoms compatible with
infections caused by these possible pathogens and pending for definitive diagnosis.
Reverse barrier nursing, also referred to a protective isolation, on the other-hand is designed to
provide a safe environment for patients who have an increased susceptibility to infection because
they have a compromised immune system like sever neutropenia, post organ transplant or extensive
skin loss due to burns or other trauma.
Hand hygiene compliance above 90%, appropriate donning and doffing of personal protective
equipment like gloves, gowns, masks / respirators, isolation, adequate attention to ventilation
requirements and proper addressal of waste and environment cleaning are extremely important to
reduce the risk of infections in patients and staff and to prevent environmental contamination.
Recent literature is advocating the implementation of horizontal infection control measures like
hand hygiene, bare below elbow, universal decolonisation etc as against vertical measures of
infection prevention like isolation and strict barrier nursing for some specific pathogens like MRSA &
VRE due to no difference in outcomes vis a vis each other and recommends healthcare organisations
making their policies based on such evidence and their own challenges.
Education, training, skilling and competency assessment are important in ensuring that healthcare
staff are adequately equipped to safely handle patients with such communicable diseases.

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Abstract 1

Prevention of Healthcare associated infections – Bundled approach

Barrier Nursing, Reverse Barrier Nursing & Isolation Practices

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