Care bundles: the holy grail of infectious risk management in hospital?

A care bundle is set of four or five processes that each individually improve patient outcome and that should be performed together for every patient every time. We describe how bundles should be designed, implemented and evaluated with measurement designed for quality improvement rather than research or judgement.

A systematic review concluded that the relative risk reduction associated with the introduction of a sepsis bundle exceeded 25%, and absolute risk reduction exceeded 9% in all studies. The number needed to treat to save one life in each study population ranged from three to 11. Bundles for the prevention of infections have focused on ventilator-associated pneumonia and catheter-associated bloodstream infections in the ICU. The most persuasive evidence of effectiveness comes from multicentre studies, but results from single ICUs provide valuable insights into how bundle implementation fits within a broader quality improvement strategy.

Care bundles can be a powerful driver for improving the reliability of delivery of evidence-based care and patient outcomes. It remains to be seen whether the success that has been achieved in acute admissions and ICUs can be reproduced in general wards.