I Love Bundles and Checklists, Until They Do Not Work!

Source: National Health Council.org

Like most hospital epidemiologists, I absolutely love bundles and checklists that standardize risk reduction practices.  These mechanisms help to optimize practice and minimize optionalism.

Unfortunately, sometimes the bundles do not work, as reported in this recently published article.

Kudos to the authors for taking a hard look at ventilator associated pneumonia (VAP) bundle compliance and impact on ventilator associated events (VAE).  Bottom line, the current bundle does little to actually impact VAE. 

Not all VAE are VAP, admittedly. Regardless, we need better protocols that encompass all aspects of ventilator safety-including infections, minimizing pulmonary edema,sedation vacations, extubations etc.

The most eye opening result of the above study: the use of chlorhexidine oral care increased the risk of VAE, a proper challenge to the paradigm of bioburden reduction.

So, once again, I love bundles and checklists until they do not work.  

Time for us to rethink the current VAP/VAE reduction process. We should avoid clinging to failed practices and critically seek new VAE risk reduction mechanisms.