Patient Name :

Bundle for Preventing Central Line Infection

UID / IPD N o. :
Age / Sex :
Consultant :
Department :

Date
Shift
Follow proper insertion practices
Perform hand hygiene before insertion
Use maximal sterile barrier precautions (i.e., mask, cap, gown, sterile gloves, and
sterile fullbody drape)
Perform skin antisepsis with >0.5% chlorhexidine with alcohol
Choose the best site to minimize infections andmechanical complications
o Avoid femoral site in adult patients
Cover the site with sterile gauze or sterile, transparent, semipermeable dressings
Handle and maintain central lines appropriately
Handle & Maintain central lines properly
Comply with hand hygiene requirements
Access catheters only with sterile devices
Replace dressings that are wet, soiled, or dislodged
Perform dressing changes under aseptic technique using clean or sterile gloves
Supplemental strategies for consideration:
2% Chlorhexidine bathing
Antimicrobial/Antiseptic impregnated catheters
Chlorhexidineimpregnated dressings

Signature of Staff / ICN

Phlebitis Scale
Grade 0
Grade 1
Grade 2
Grade 3

Grade 4

Date
Shift
No symptoms
Erythema at access site with / without pain
Pain at access site with erythema and / or
oedema
Pain at access site with erythema and / or
oedema, streak formation, palpable venous
cord
Pain at access site with erythema and / or
oedema, streak formation, palpable venous
cord greater than one inch in length & purulent
drainage

NAME / SIGNATURE
Action Taken ( If required ) :

M
Canula Change (Yes / No)

Grade

Bundle for preventing catheter related infections

Patient Name :

Reg N o. :
Age / Sex :

Department :

Date
Shift
Does patient still require indwelling urinary catheter?
Remove if possible

Is the indwelling urinary catheter continuously

connected to the drainage system and changed in line
with manufacturers recommendations?
Meatal hygiene has been performed?

Is hand hygiene performed immediately prior to

access or manipulation of the indwelling urinary
catheter?

Is the drainage bag situated below the bladder level

and the tap is not in contact with any surface e.g.
floor?

Ventilator Bundle Checklist

Patient Name

Admission Date ...

Date and Time of Intubation

Dade & Time Vvantilator off .

Age / Sex ...

S.No
Bundles
Day-1

IPD NoHUID No
Day-2
Day-3
Day-4
Day-5

Head of bed 30-45 degree

Daily Sedation Vacation

Daily Assessment of readiness to wean

Daily Spontaneous Breathing Trial

PUD Prophylaxsis
(Peptic Ulcer Disease)

DVT Prophylaxis
(Deep Vei nThrombosis)

Oral hygiene(Mouth Care)

Signature of Evaluator

Ventilator Bundle Checklist

Patient Name

Admission Date ...

Date and Time of Intubation

Dade & Time Vvantilator off .

Age / Sex ...

S.No
Bundles
Day-1

IPD NoHUID No
Day-2
Day-3
Day-4
Day-5

Head of bed 30-45 degree

Daily Sedation Vacation

Daily Assessment of readiness to wean

Daily Spontaneous Breathing Trial

PUD Prophylaxsis
(Peptic Ulcer Disease)

DVT Prophylaxis
(Deep Vein Thrombosis)

Oral hygiene(Mouth Care)

Signature of Evaluator

...

Day-6
Day-7

Day-8

...

Day-6
Day-7

Day-8