Bundles of Bundles

Abstract

Possibly the first time many of us became familiar with the concept of a healthcare associated infection (HAI) prevention bundle was when Pronovost published his Michigan study that demonstrated an evidence based intervention (a bundle) significantly reduced catheter related bloodstream infections in an ICU setting[1]. HAI prevention interventions are often multimodal, which intuitively makes sense, given as it is often difficult to identify the one causative factor. So instead of focussing on just one intervention, we identify several and combine them together into a bundle (as we picture the arrow passing through the holes in the cheese). The success of a bundle depends on several key factors. They must be composed of only 2–5 simple evidence based components, they must be accompanied by an implementation strategy, and crucially, their success depends on high compliance with all the bundle components[2]. Since Pronovosts study, a variety of infection prevention bundles have been described. For example intervention bundles to prevent catheter associated urinary tract infections[3], a bundle to prevent surgical site infections in colorectal surgery[4], and most recently an environmental cleaning bundle to reduce HAI[5]. Whilst some HAI prevention bundles would appear to be widely implemented and clearly effective, others require further exploration.