Thursday, April 14, 2011

Much ado about bundles

Following yesterdays post about bundles, a couple of interesting papers from this weeks NEJM. Two studies here and here, and an editorial about reducing infection in hospitals. The two studies came to different conclusions; the first examined the efficacy of screening for MRSA in ICUs and implementing barrier precautions on all patients until their MRSA status was known. The interventions were not shown to be effective in reducing transmission of MRSA or VRE. However, and this is the really big take home message for me, in cases where hand hygeine or glovers were indicated, the compliance with these measures was as low as 62%!
In contrast, the VA study instituted a bundle approach; a MRSA bundle was instituted in 2007 and over 2 million hospital discharges were studied. The rate of health care associated MRSA infections fell by between 45% (outside ICU) and 62% (inside ICU) over a two year period.
For some expert comment, see this CDC post.

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