Guidelines for severe infections: are they useful?

The large variability in clinical practice plus the increasing awareness that certain processes of care are associated with improved medical outcomes has led to the development of clinical practice guidelines in serious infection. The evolution of guidelines and their impact on delivery of care in severe infection is reviewed.

Guidelines development has centered around community- and hospital-acquired pneumonia as well as sepsis. The Institute of Healthcare Improvement has emerged as an international leader in changing healthcare professional behavior to be consistent with clinical recommendations in infection-related morbidity. These educational programs are designed to increase awareness of guidelines recommendations and to optimize their implementation. Change bundles are selected sets of interventions or processes distilled from evidence-based practice guidelines that are likely to improve outcome. As new evidence is published, and as experts ponder how the guidelines should best be expressed in the bundles, the bundles will be adapted to optimize their utility.

The change bundle approach to performance improvement (guidelines-based) is the key to change in practice. The Surviving Sepsis Campaign/Institute of Healthcare Improvement sepsis change bundles are an excellent example of progress along these lines.