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While it appears that instituting bundle policies is becoming common (a CL Bundle policy was present in almost half of our ICUs), only a disappointing 38% of those that monitored bundle implementation reported full compliance.
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With greater insights into customer behavior, the company could market additional services or content to its wireless subscribers as part of a bundle, policy analysts say.
For example, the pricing decisions of two complementary products as the bundle policy is studied by Yue et al. (2006) where the products are produced by two separate firms.
In multivariate analyses, we initially examined if simply having a CL Bundle policy in place led to lower CLABSI rates, but this was not the case.
We found that only when an ICU had a bundle policy, monitored compliance with it, and had 95% or greater compliance did CLABSI rates decrease.
Similarly, monitoring compliance with a bundle policy but having less than ideal compliance (<95%) showed no association with lower CLABSI rates.
This is significant because we found that there was no relationship between simply having a bundle policy in place and lower infection rates.
In 250 hospitals the mean CLABSI rate was 2.1 per 1000 central line days and 49% reported having a written CL Bundle policy.
Because we hypothesized that having policies alone was insufficient to decrease infection rates, for each bundle component, respondents were asked: a) whether the ICU had a written CL Bundle policy in place; b) whether compliance was monitored; and c) if so, how often compliance was observed (all of the time/95% - 100%; usually/75% - 94%, sometimes/25% - 74%, rarely or never/<25%; and don't know).
29 studies that met the eligibility criteria (ie, economic evaluations, cluster-randomised trials, non-randomised trials, controlled before-and-after studies, and interrupted time-series studies exploring the effective of these interventions) were categorised according to intervention type: multimodal, care bundles, policies, and surveillance, monitoring, and feedback.
Bundling policies encourages a "set it and forget it" mentality, but automatically renewing year after year with the same company could come at a cost.
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