"You destroyed the bundles"

While at ICAAC over the weekend, I attended a symposium on infection prevention bundles. This excellent session began with Marc Bonten doing a (very) critical review of the literature in support of bundles for VAP and MRSA prevention, after which our own Eli Perencevich discussed how one might begin to parse out which elements of our current bundles are the most important. After these two compelling talks, a young man (an infection preventionist from Italy, I think) approached the microphone with a declaration and a question: “You have destroyed the bundles! What shall we do now?”

I’m hard-pressed to answer this question, except to say that it would be wise to refrain from starting with bundles that have one element that is hugely expensive and of uncertain effectiveness, lest we end up wasting millions on expensive screening tests when “horizontal” infection control measures will suffice.

In other news, R.E.M. has broken up after 31 years. R.E.M. was my soundtrack through medical school and residency training, and their pre-1994 repertoire is still in heavy rotation in my head and on my iPod. So in honor of R.E.M. and in honor of Eli, destroyer of bundles, I give you R.E.M.’s Cuyahoga: