Preventing healthcare-associated infections: the care bundles
- Safe practice
Small sets of evidence-based measures that, applied together in every patient, prevent infections from catheters, lines, ventilators and surgery.
What it is
A care bundle is a short set of evidence-based practices applied together, in every patient, with compliance measured. The most widely used ones prevent four healthcare-associated infections: catheter-associated urinary tract infection, central line-associated bloodstream infection, ventilator-associated pneumonia and surgical site infection. Nursing sustains most of these measures day to day: aseptic insertion, careful maintenance, patient positioning, oral care and, above all, asking every day whether the device is still needed.
What it requires
- Staff trained to insert and maintain each device.
- Hand hygiene before and after inserting or handling any device.
- Checklists and the authority to stop an insertion that breaks technique.
- Surveillance of infection rates and feedback to the team.
Components
- Catheter-associated urinary tract infection: indication, insertion, maintenance, removal.
- Central line-associated bloodstream infection: insertion, site care, port access, removal.
- Ventilator-associated pneumonia: avoiding intubation, sedation, positioning, oral care, nutrition.
- Surgical site infection: preparation, operating room, postoperative care.
How it is applied (and why)
- Check the indication before inserting a urinary catheter or a line — a device that is not placed cannot get infected.
- Insert with aseptic technique and sterile supplies; for a central line, cap, mask, sterile gown and gloves and a large drape — it keeps germs out.
- Prepare the central-line site with alcoholic chlorhexidine and let it dry — the antiseptic needs contact time.
- Keep the catheter system closed, unkinked, with the bag below the bladder and off the floor — it prevents reflux and contamination.
- Disinfect the port or connector before every access and change the dressing if damp, loose or soiled — it protects the entry route.
- In a ventilated patient, raise the head of the bed to 30–45° and give daily oral care with toothbrushing — it reduces aspiration of secretions.
- Support lighter sedation, the daily extubation trial and early mobilisation — fewer ventilator days, less pneumonia.
- For surgery, do not remove hair unless it interferes and keep the patient normothermic — it reduces surgical site infection.
- Ask every day whether the catheter or line is still needed and remove it when not — the risk grows with every day of use.
Main elements of each bundle
| Infection | At insertion or before | Maintenance | Removal or follow-up |
|---|---|---|---|
| Catheter-associated urinary tract infection | Appropriate indication, trained staff, aseptic technique and sterile supplies, secure the catheter | Closed system, free flow, bag below the bladder and off the floor, separate container to empty it, meatal hygiene without antiseptics | Remove as soon as not needed; after surgery, ideally within 24 h; nurse-led removal protocols |
| Central line-associated bloodstream infection | Hand hygiene, maximal sterile barriers, alcoholic chlorhexidine, avoid the femoral vein in adults | Disinfect the port before every access; sterile dressing, changed if damp, loose or soiled | Daily review of need and prompt removal if not essential |
| Ventilator-associated pneumonia | Avoid intubation with high-flow oxygen or non-invasive ventilation when safe | Head of bed at 30–45°, minimal sedation, daily toothbrushing, early enteral nutrition, circuit changed only if soiled or faulty | Daily awakening and spontaneous breathing trials; early mobilisation |
| Surgical site infection | Antibiotic prophylaxis at the time the protocol sets, no hair removal unless it interferes, alcohol-based antiseptic on the skin | Normothermia during surgery | Postoperative glucose control, surveillance, patient and family education |
In nursing practice
- A urinary catheter is not used in place of incontinence care, or to get a sample when the patient can void.
- Daily meatal hygiene with soap and water is enough; periurethral antiseptics do not prevent infection.
- For oral care of the ventilated patient, toothbrushing without chlorhexidine is preferred.
- Catheters and bags are changed for a clinical reason, not on a fixed schedule.
Common mistakes
- Leaving the drainage bag on the floor or above the bladder.
- Accessing a central line without disinfecting the connector.
- Lowering the head of the ventilated patient's bed during care and forgetting to raise it again.
- Keeping a catheter or line out of habit, without reviewing whether it is still needed.
- Shaving the skin before surgery.
Test yourself
Think of the answer, then tap the question to see it.
What is a care bundle?
A short set of evidence-based practices applied together in every patient, with compliance measured, to prevent a specific infection.
Where should a urinary catheter drainage bag be?
Always below the level of the bladder, with no kinks in the tubing and never resting on the floor.
Which maximal sterile barriers are used when inserting a central venous catheter?
Cap, mask, sterile gown, sterile gloves and a sterile drape covering the patient's whole body.
How high is the head of the bed raised to prevent ventilator-associated pneumonia?
Between 30 and 45 degrees, unless contraindicated.
Which daily question do all the device bundles share?
Whether the catheter, line or ventilator is still needed. Removing it as soon as it is not is the most effective measure.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009): Summary of Recommendations (Centers for Disease Control and Prevention (CDC), 2009); Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011): Summary of Recommendations (Centers for Disease Control and Prevention (CDC), 2011); Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update (Infection Control & Hospital Epidemiology (SHEA), via PubMed Central, 2022); Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update (Infection Control & Hospital Epidemiology (SHEA), via PubMed Central, 2023).
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Representative model, for educational purposes only.