Device-Associated Infection Prevention Bundles

Daily ward round on a ventilated patient with a central line, an arterial line and a urinary catheter on day 5

• New erythema or pus at a line site
• New fever with no source in a patient with devices
• Rising ventilator requirement with new secretions
• A device nobody can justify

• Catheter-related bloodstream infection
• Ventilator-associated pneumonia
• Catheter-associated urinary infection
• Surgical site infection
• Non-infective fever (drug, thrombosis, transfusion)

• Admit: Not an admission diagnosis — a daily standard for every ICU and ward patient
• ICU: Applies to every ICU patient with an invasive device

• The most effective bundle item is asking daily whether each device is still needed.
• CLABSI: chlorhexidine, full barrier, avoid femoral, scrub the hub, remove early.
• VAP: head up 30–45°, daily sedation hold + SBT, toothbrushing, cuff 20–30 cm H₂O.

• Treat asymptomatic bacteriuria (except pregnancy and before urological procedures)
• Leave a line in because it is working
• Continue surgical prophylaxis beyond 24 h for drains or lines
• Culture a colonised device instead of removing it

• Treating asymptomatic bacteriuria
• Sending a culture from a colonised device instead of removing it
• Leaving a line in 'because it is working'
• Continuing surgical prophylaxis for days
• Running the bundle only when an audit is due

A daily process, not an event: the ward round checklist, the stop date and the device review are the intervention.