Quick cards

Prevention Bundles

Isolation by organism, pressure injury, central line and urinary catheter care

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Central line care

CLABSI prevention after insertion: bathing, hubs, dressings, tubing, daily review

After insertion (SHEA 2022, CDC 2011)

Chlorhexidine bath	Daily for ICU patients over 2 months old with 2% CHG cloths; not on the face or mucous membranes; no rinsing
Scrub the hub	Every access: CHG-alcohol (preferred) or 70% alcohol with friction for at least 5 s, then let dry; or antiseptic caps
Transparent dressing	CHG dressing with site care at least every 7 days; sooner if damp, loose or soiled
Gauze dressing	Every 2 days, sooner if damp, loose or soiled; for an oozing site or sweaty skin
Tubing	Continuous sets every 96 h to 7 days; blood or lipids within 24 h; propofol every 12 h (label)
Needleless connectors	Change with the administration set; no benefit from changing more often than every 72 h (CDC 2011)
Daily review	Is every line still needed? Remove it the day it is not; no scheduled line changes
Emergency-placed line	Replace within 48 h when sterile technique could not be ensured (CDC 2011)

Suspected line infection: paired blood cultures from the line and a peripheral vein before antibiotics; growth from the line 2 h or more earlier implicates it (IDSA 2009).

Urinary catheters

CAUTI prevention: indications, nurse-driven removal and maintenance (SHEA 2022)

Appropriate indications

Acute retention: scanned residual over 500 mL, or over 300 mL with bladder pain or fullness
Hourly urine output that is changing therapy (resuscitation, diuresis, pressor titration)
Selected surgery; a catheter placed only for a long case comes out at the end of it
Healing an open pressure injury or skin graft in selected incontinent patients
Comfort at the end of life, if the patient wants it
CDC 2009 also lists prolonged immobilization (unstable spine, pelvic fractures)
Not indications: incontinence, convenience, ICU status alone, a urine sample from someone who can void

Nurse-driven removal

Each day, check the catheter against the indication list
No indication left: remove it under the protocol and document
After surgery: remove as soon as possible, ideally within 24 h (CDC 2009)
Watch for voiding; bladder scan if none by the protocol time or with discomfort
Retention: intermittent catheterization before a new Foley; external catheter for incontinence

Maintenance

Closed system: never disconnect the catheter from the tubing
Bag below the bladder and off the floor; tubing free of kinks and dependent loops
Empty into a clean container for each patient; the spout never touches it
Secure the catheter against traction; smallest workable size
Routine meatal hygiene with soap and water; no antiseptic cleaning (CDC 2009 advises against it; SHEA 2022: unresolved)
No scheduled catheter or bag changes and no routine irrigation
Culture only for fever, altered mental status or new sepsis with no other source, flank pain, acute hematuria or new pelvic discomfort
Sample from the disinfected port, never the bag; cloudy or smelly urine or pyuria alone is no reason to culture

Pressure injury

Braden bands, NPIAP stages, device injuries, turning and surfaces

Braden scale (6–23; lower is worse)

Subscales	Sensory perception, moisture, activity, mobility, nutrition (1–4 each); friction and shear (1–3)
19–23	Not at risk; reassess per policy and with any change
15–18	Mild risk: start prevention (turning, heels, moisture, nutrition)
13–14	Moderate risk
10–12	High risk
9 or less	Very high risk

NPIAP stages (2016)

Stage 1	Intact skin with non-blanchable redness (may look different in dark skin); purple or maroon suggests deep tissue injury
Stage 2	Partial thickness: pink, moist dermis or a serum blister; no fat, slough or eschar. Not for moisture damage or skin tears
Stage 3	Full thickness skin loss with fat visible; may have slough, eschar, undermining or tunneling; no fascia, muscle or bone
Stage 4	Full thickness skin and tissue loss with fascia, muscle, tendon, ligament, cartilage or bone exposed or palpable
Unstageable	Full thickness loss hidden by slough or eschar; leave stable dry eschar on a heel or ischemic limb in place
Deep tissue (DTPI)	Persistent non-blanchable deep red, maroon or purple area, or a blood-filled blister; may open fast
Device-related	Takes the shape of the device and is staged the same way; injury on mucous membranes is not staged

Prevention

Devices	ETT, NG, NIV mask, collar, SpO₂ probe, tubing: pad, rotate and lift; check under them at least twice daily, more with edema
Turning	Individualized, often every 2 h; 30° side tilt; small shifts if unstable; float heels fully off the bed
Head of bed	As low as allowed, to limit shear; 30° meets the VAP minimum in ventilated patients
Support surface	High-specification foam for anyone at risk; alternating pressure or low-air-loss for high risk or an existing injury
Prophylactic dressing	Silicone multilayer foam on sacrum and heels in at-risk patients (2019 international guideline)
Moisture and nutrition	Prompt incontinence care, barrier product; with an injury and malnutrition risk: 30–35 kcal/kg and protein 1.25–1.5 g/kg a day

Do not reverse-stage: a healing stage 4 stays a healing stage 4. Moisture damage, skin tears and burns are not pressure injuries.

Isolation precautions

Precaution type, room and PPE by organism (CDC 2007 guideline with updates)

Precaution types

Standard	Every patient: hand hygiene, PPE for the expected exposure, respiratory hygiene, safe injections
Contact	Gown and gloves on entry, off before leaving; private room or cohort; dedicated stethoscope and BP cuff
Contact (enteric)	Contact PPE plus soap-and-water hand washing, sporicidal (bleach) cleaning and a dedicated toilet or commode
Droplet	Surgical mask on entry; private room, or beds 3 ft apart with the curtain drawn; mask the patient to move
Airborne	Fit-tested N95 or PAPR before entry; AIIR (negative pressure, 12 air changes/h new, 6 older), door closed; mask the patient to move

Respiratory spread

Tuberculosis, pulmonary or laryngeal	Airborne: AIIR and N95; until improving on therapy with 3 negative AFB smears, or TB is ruled out
Measles	Airborne: AIIR; N95 for all staff, immune or not; until 4 days after rash onset (whole illness if immunocompromised)
Varicella, disseminated zoster	Airborne plus contact: AIIR, N95, gown, gloves; immune staff preferred; until all lesions are dry and crusted
Localized zoster	Standard with lesions covered if immunocompetent; airborne plus contact if immunocompromised until dissemination is ruled out
Influenza	Droplet for 7 days or until 24 h after symptoms end, whichever is longer; aerosol procedures: N95, gown, gloves, eye protection
COVID-19	N95, gown, gloves, eye protection; single room, door shut, AIIR for AGPs; 10 days, up to 20 if severe; test-based end if immunocompromised
Meningococcus	Droplet until 24 h of effective antibiotics; prophylaxis for staff with unmasked airway exposure (intubation, suctioning)
Pertussis	Droplet until 5 days of effective antibiotics; private room preferred

Contact spread

MRSA	Contact (SHEA 2022; a hospital may modify after a risk assessment); ICU decolonization: daily CHG bath plus 5 days of nasal mupirocin
VRE	Contact per hospital policy; dedicated equipment; thorough daily and discharge cleaning
CRE	Contact; single room and dedicated equipment; flag the chart and warn the receiving unit at transfer
Candida auris	Contact for the whole stay (colonization persists); single room; EPA List P disinfectant, since quaternary ammonium alone fails
C. difficile	Contact (enteric) from suspicion, before the result, until at least 48 h after diarrhea stops (IDSA/SHEA 2017); soap and water; bleach
Norovirus	Contact (enteric); mask and eye protection if vomit may splash; soap and water; bleach; until 48 h after symptoms end
Scabies	Contact until 24 h after effective treatment; crusted scabies is far more contagious: private room, treat exposed staff per policy

Practice free in your browser2,150+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.

For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow the order, the label and your institution's protocols.