Chart — Infection Control
Infection Prevention Bundles
Bundle elements, nursing priorities, and clinical monitoring criteria for the four major preventable healthcare-associated infections. Organized for rapid reference and bedside use.
Educational use only. Based on CDC, IHI, NHSN, and AHRQ evidence-based prevention guidelines. Implement per current facility protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Quick Comparison
| HAI | Device / Source | Top Prevention Strategy | Nursing Priority |
|---|---|---|---|
| CAUTI | Urinary catheter | Daily necessity review + prompt removal | Advocate for removal |
| CLABSI | Central venous catheter (CVC) | Scrub the hub every access (≥15 sec) | Line access technique |
| VAP | Endotracheal tube / mechanical ventilator | HOB 30–45° + daily SAT/SBT | Positioning + oral care |
| SSI | Surgical incision (no indwelling device) | Antibiotics ≤60 min pre-incision | Timing and wound surveillance |
CAUTI Bundle — Catheter-Associated Urinary Tract Infection
Most common HAI (~30–40% of all HAIs)
| Bundle Element | Action |
|---|---|
| Avoid insertion | Insert urinary catheter only when medically necessary — consider alternatives (condom catheter, intermittent catheterization, incontinence products) |
| Sterile technique | Use sterile insertion technique every time; trained personnel only |
| Closed drainage | Maintain closed drainage system; never disconnect tubing; replace immediately if broken |
| Dependent drainage | Keep drainage bag below bladder level at all times; never place bag on floor |
| Secure catheter | Secure catheter to prevent urethral traction and movement |
| Daily review | Assess catheter necessity daily; document indication; remove when no longer needed |
| Perineal hygiene | Soap and water cleansing daily and after bowel movements; avoid antiseptic cleansers on the meatus |
| Avoid irrigation | Do not irrigate routinely; only irrigate if ordered for specific clinical indication |
Nursing Priority
Daily necessity review and prompt removal is the highest-impact nursing-driven CAUTI intervention.
Monitor For
- ·Fever or change in mental status with catheter in place
- ·Change in urine characteristics (cloudiness, odor, hematuria)
- ·Suprapubic or flank discomfort
CLABSI Bundle — Central Line-Associated Bloodstream Infection
12–25% mortality; most costly HAI per case
| Bundle Element | Action |
|---|---|
| Hand hygiene | Perform hand hygiene before any central line access, dressing change, or insertion — no exceptions |
| Maximal sterile barrier | During insertion: cap, mask, sterile gown, sterile gloves, large sterile drape covering patient body |
| Chlorhexidine skin prep | Apply chlorhexidine-alcohol to insertion site; allow to fully dry before proceeding |
| Optimal site selection | Subclavian preferred; internal jugular acceptable; avoid femoral when possible |
| Scrub the hub | Scrub each hub for ≥15 seconds with chlorhexidine or 70% isopropyl alcohol before every access |
| Chlorhexidine dressing | Apply chlorhexidine-impregnated dressing or disk at insertion site; change per facility policy |
| Daily review | Assess central line necessity daily; remove promptly when no longer clinically indicated |
| Tubing changes | Change IV tubing per facility policy; blood and lipid tubing every 24 hours |
Nursing Priority
Scrub the hub every single time — 15 seconds minimum with chlorhexidine or 70% alcohol before any lumen access.
Monitor For
- ·Fever, chills, or rigors with central line in place
- ·Erythema, warmth, or drainage at insertion site
- ·Signs of sepsis (tachycardia, hypotension, altered mental status)
VAP Bundle — Ventilator-Associated Pneumonia
9–27% of ventilated patients; 20–50% mortality
| Bundle Element | Action |
|---|---|
| HOB elevation | Head-of-bed elevation 30–45° continuously unless contraindicated; verify with angle-measuring tool — not visual estimate |
| Oral care | Provide daily oral care with toothbrushing (e.g., every 12 hours), but WITHOUT chlorhexidine; routine chlorhexidine oral care is no longer recommended for VAP prevention (2022 SHEA/IDSA Compendium) — it lacks clear VAP benefit and carries an uncertain mortality signal |
| SAT | Daily Spontaneous Awakening Trial — interrupt continuous sedation daily to assess neurological status |
| SBT | Daily Spontaneous Breathing Trial paired with SAT — assess readiness for extubation |
| ETT cuff pressure | Maintain endotracheal tube cuff pressure 20–30 cmH₂O — prevents aspiration of secretions past cuff |
| Subglottic drainage | Use ETT with subglottic suction port; drain accumulated secretions every 2–4 hours |
| Avoid circuit changes | Do not change ventilator circuits on a scheduled basis; change only when visibly soiled or malfunctioning |
| Mobilization | Initiate passive ROM and progressive mobility protocol as early as clinically appropriate |
Nursing Priority
HOB elevation 30–45° is the highest-impact, lowest-cost VAP prevention intervention — it must be continuously maintained, not just during rounds.
Monitor For
- ·New fever or temperature spike
- ·Increased or changing sputum quantity or character
- ·Decreased SpO₂ or increased FiO₂ requirement
- ·New infiltrate on chest X-ray
- ·Leukocytosis or leukopenia
SSI Bundle — Surgical Site Infection
~20% of HAIs; 7–11 additional hospital days
| Bundle Element | Action |
|---|---|
| Prophylactic antibiotics | Administer facility-approved antibiotic within 60 minutes before incision; re-dose for procedures lasting > 4 hours |
| Hair removal | Use clippers (not razor) immediately before surgery only if removal is necessary; avoid shaving the night before |
| Skin preparation | Chlorhexidine-alcohol skin prep at incision site; allow to fully dry before draping |
| Normothermia | Maintain patient temperature ≥36°C perioperatively; apply active warming devices preoperatively and intraoperatively |
| Glycemic control | Target blood glucose < 180 mg/dL perioperatively; avoid hypoglycemia; insulin infusion if needed |
| Sterile technique | Maintain sterile field throughout procedure and postoperative wound care |
| Wound assessment | Assess wound at every dressing change: color, drainage (color, amount, odor), warmth, approximation, edema |
| Patient education | Smoking cessation preoperatively; glycemic management; wound monitoring; when to contact provider after discharge |
Nursing Priority
Perioperative antibiotics must be administered within 60 minutes before incision — nursing must confirm administration and timing before the patient is taken to the OR.
Monitor For
- ·Erythema, warmth, induration at wound edges
- ·Purulent or excessive wound drainage
- ·Fever (postoperative day 3–5 is peak SSI risk window)
- ·Wound dehiscence or separation
- ·Elevated WBC or elevated CRP
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with CDC / IHI / NHSN HAI Prevention Bundle Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →