A 62-year-old male is in the medical-surgical ICU on postoperative day 2 following a subtotal colectomy for perforated diverticulitis. He has a triple-lumen central venous catheter (CVC) in the right internal jugular vein inserted 4 days ago, an indwelling urinary catheter, and a stapled midline abdominal incision. The charge nurse is conducting an HAI prevention bundle compliance audit. Which nursing actions are consistent with evidence-based HAI prevention bundles? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Maintain perioperative and early postoperative glucose below 180 mg/dL and preserve normothermia to reduce surgical-site infection risk (Choice 1). Use maximal sterile barrier precautions during CVC insertion (Choice 2). Verify timely preoperative antibiotic prophylaxis and appropriate postoperative discontinuation (Choice 3). Daily chlorhexidine bathing and CVC-site assessment support CLABSI prevention (Choice 4). Review urinary-catheter necessity every day and remove it promptly when no longer indicated (Choice 5). Keep the urinary drainage bag below bladder level; raising it above the bladder promotes reflux and increases CAUTI risk (Choice 6).
Clinical Judgment Three simultaneous HAI risks are present: CLABSI (CVC day 4), CAUTI (indwelling catheter), and SSI (post-colectomy). Each HAI has its own prevention bundle. The distractor (option 3) exploits a common misconception — elevating the drainage bag seems logical but reverses gravity and causes urinary reflux, increasing CAUTI risk.
Memory Tip CLABSI bundle: Hand hygiene + MSB at insertion + CHG antisepsis + Optimal site (subclavian/PICC) + Daily necessity review + Daily CHG bathing CAUTI bundle: Indication-only insertion + Aseptic technique + Closed drainage system + Bag ALWAYS below bladder + Daily removal review SSI bundle: Antibiotics within 60 min pre-incision + Discontinue within 24 h + Normothermia + Glucose <180 + Clippers only (no razors)
KR vs US In Korean ICUs, CHG bathing protocols are less standardized than in the US. The CDC NHSN tracks CLABSI and CAUTI as reportable HAIs tied to hospital reimbursement, driving strong bundle adherence. NCLEX expects the US CDC/IHI bundle standard.
Clinical Practice GuideIHI Central Line Bundle (5 elements): (1) Hand hygiene; (2) Maximal sterile barrier at insertion; (3) CHG skin antisepsis; (4) Optimal catheter site (subclavian/PICC preferred, avoid femoral); (5) Daily review and prompt removal. Daily CHG bathing is recommended as a 6th evidence-based element.
CAUTI Prevention (HICPAC): Insert only when indicated; use smallest effective catheter; maintain closed drainage; keep bag below bladder at all times; secure catheter; daily removal review — nurse-driven removal protocols allow removal without a physician order at many facilities.
SSI Prevention Bundle (CDC 2017/ACS): Prophylactic antibiotics within 60 min of incision (120 min for vancomycin/fluoroquinolones); discontinue within 24 h (48 h for cardiac); maintain normothermia; blood glucose <180 mg/dL; preoperative CHG shower; hair removal with clippers only.
CLABSI (Central Line-Associated Bloodstream Infection) — CLABSI definition (CDC/NHSN): A primary bloodstream infection in a patient who had a central line within 48 hours before infection onset. MSB at insertion and daily CHG bathing are the two most impactful CLABSI prevention elements.
CAUTI (Catheter-Associated Urinary Tract Infection) — CAUTI definition (CDC/NHSN): A UTI in a patient who had an indwelling urinary catheter in place for more than 2 calendar days on the date of the infection event. Nurse-driven removal protocols eliminate physician-order delays and reduce CAUTI rates by approximately 50%.
SSI (Surgical Site Infection) — SSI classification (CDC): Superficial incisional (skin/subcutaneous), Deep incisional (fascia/muscle), Organ/Space (e.g., intraabdominal). Colorectal surgery carries the highest SSI risk among elective procedures. Prophylactic antibiotic timing is the single highest-yield SSI prevention measure.