Chapter 125. Health Care– Associated Infections (Part 3) Nosocomial and Device-Related Infections The fact that 25–50% or more of nosocomial infections are due to the combined effect of the patient's own flora and invasive devices highlights the importance of improvements in the use and design of such devices. Intensive education and "bundling" of evidence-based interventions (Table 125-2) can reduce infection rates through improved asepsis in handling and earlier removal of invasive devices, but the maintenance of such gains requires ongoing efforts. It is especially noteworthy that turnover or shortages of trained personnel jeopardize safe and effective patient care and have been associated with increased infection rates. Table 125-2 Examples of "Bundled Interventions" to Prevent Common Health Care–Associated Infections and Other Adverse Events Prevention of Central Venous Catheter Infections Educate personnel about catheter insertion and care. Use chlorhexidine to prepare the insertion site. Use maximum barrier precautions during catheter insertion. Ask daily: Is the catheter needed? Prevention of Ventilator-Associated Pneumonia and Complications Elevate head of bed to 30–45 degrees. Give "sedation vacation" and assess readiness to extubate daily. Use peptic ulcer disease prophylaxis. Use deep-vein thrombosis prophylaxis (unless contraindicated). Prevention of Surgical-Site Infections Administer prophylactic antibiotics within 1 h before surgery; discontinue within 24 h. Limit any hair remov al to the time of surgery; use clippers or do not remove hair at all. Maintain normal perioperative glucose levels (cardiac surgery patients). a Maintain perioperative normothermia (colorectal surgery patients). a Prevention of Urinary Tract Infections Place bladder catheters only when absolutely needed (e.g., to relieve obstruction), not solely for the provider's convenience. Use aseptic technique for catheter insertion and urinary tract instrumentation. Minimize manipulation or opening of drainage systems. Remove bladder catheters as soon as is feasible. a These components of care are supported by clinical trials and experimental evidence in the specified populations; they may prove valuable for other surgical patients as well. Source: Adapted f rom information presented at the following websites: www.cdc.gov/ncidod/dhqp/gl_intravascular.html; www.cdc.gov/ncidod/dhqp/gl_hcpneumonia.html; www.cdc.gov/ncidod/dhqp/gl_surgicalsite.html; www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html; www.ihi.org ; www.medqic.org/scip. . Chapter 125. Health Care– Associated Infections (Part 3) Nosocomial and Device-Related Infections The fact that 25–50% or more of nosocomial infections are due to the. patient care and have been associated with increased infection rates. Table 125- 2 Examples of "Bundled Interventions" to Prevent Common Health Care Associated Infections and Other Adverse. such devices. Intensive education and "bundling" of evidence-based interventions (Table 125- 2) can reduce infection rates through improved asepsis in handling and earlier removal of invasive