Beyond the Bundles: How to Implement Best Practices at the Bedside

January 12th, 2015

Joint Commission Resources has issued tips and strategies to take infection control to the patient beside.

Beyond the Bundles: How to Implement Best Practices at the Bedside addresses both infectious and non-infectious adverse events, including drug events, catheter associated urinary tract infection (CAUTI), central line associated blood stream infection, early elective delivery, injuries from falls and immobility, pressure ulcers, surgical site infection, ventilator associated pneumonia, and venous thromboembolism.

It also includes an overview on how to use performance improvement methods for sustainable results, as well as how to reduce readmission cases. Produced by the JCR Hospital Engagement Network (HEN), the guide is part of the national Partnership for Patients (PFP) initiative and is free to those who register on the JCR site.

In reviewing prevention strategies for CAUTIs, for example, Joint Commission Resources advises the following:

1. Avoid unnecessary catheters – use protocol for Foley catheter indications for insertion/removal

2. Use aseptic technique and standardized guidelines for insertion

 Use appropriate hand hygiene practices

 Insert catheters using aseptic technique and sterile equipment

 Don gloves and drape patient

 Use sterile or antiseptic solution for cleaning urethral meatus during insertion

 Use single‐use packet of sterile lubricant for insertion

 Use the smallest catheter possible to minimize trauma to the urethra

3. Maintain indwelling catheters based on recommended guidelines

 Assess daily necessity and remove promptly when no longer needed

 Standardize care, treatment, supplies and maintenance

 Perform routine hygiene (e.g., cleansing of the meatal surface with soap and water during daily bathing or showering)

 Maintain a sterile, continuously closed drainage system.

 Collect urine specimens aseptically

 Keep drainage bag below the level of the bladder at all times to prevent backflow and enable unobstructed flow

 Protect the collection bag drain spigot from contamination – empty the collection bag regularly, use a separate collecting container for

each patient and avoid allowing the draining spigot to touch the collecting container

 Empty the collection bag regularly using a separate collection container for each patient

 Secure indwelling catheters after insertion to prevent movement and urethral traction

4. Review Urinary Catheter Necessity

 Place insertion date on catheter bag

 Remove catheter as soon as possible and according to hospital protocol and best practice evidence

 Participate in Daily Necessity Rounds

 Automate hard stop for catheter discontinuation orders 48‐72 hours after insertion

 Consider implementation of nurse‐driven protocols for discontinuation.