Effectiveness of Preventive Surgical Site Infection Bundle in Colorectal Surgery: A Collaborative Program for Improving Surgical Care and Recovery

Autor: Caroline Williams, May Mei-Sheng Riley, Suzy Dedekam, John Van Speybroeck, Sarah Park
Rok vydání: 2020
Předmět:
Zdroj: American Journal of Infection Control. 48:S31-S32
ISSN: 0196-6553
DOI: 10.1016/j.ajic.2020.06.081
Popis: Background Surgical site infection (SSI) following colorectal surgery is a common infectious complication and is associated with high mortality and increased medical costs. The Infection Preventionists (IPs) identified a high colorectal surgery (COLO) SSI incidence during surveillance. The purpose of this study is to demonstrate the effectiveness of COLO SSI reduction by initiating an evidence-based Improving Surgical Care and Recovery (ISCR) program. Methods This ISCR program was launched in March 2018. Pre-intervention was from January 2017 to February 2018. Post-intervention was from March 2018 to October 2019. Post-intervention data was compared with pre-intervention data to gauge effectiveness. A manufacturer's stapler recall was announced in April 2019. Malfunctioning staplers were used in surgeries from October to April 2019 (impact period). Electronic medical records were reviewed. Cases were identified using National Healthcare Safety Network (NHSN) SSI definitions. COLO SSI standardized infection ratios (SIR) were obtained from NHSN “Adult all SSI by procedure” data. Direct observation was performed by IPs. Potential deficiencies were identified using a self-administered staff survey. Recommendations were made to limit personnel traffic, improve surgical hand scrub, use chlorhexidine gluconate (CHG) for pre-surgery skin decolonization, manage glucose perioperatively/intraoperatively/postoperatively, maintain perioperative normothermia, deliver proper antimicrobial prophylaxis, and use CHG for skin preparation. Oral antibiotics and mechanical bowel preparation for elective colorectal surgery were implemented. Results Pre-intervention SIR was 2.50 including 28% superficial infections (SIP), 20% deep incision infections (DIP), and 52% intra-abdominal infections (IAB). Post-intervention SIR was 0.86 including 17% SIP, 17% DIP, and 67% IAB. Three IAB SSI cases had surgeries during the impact period. (Post-intervention vs. pre-intervention: relative ratio “RR”=0.34, 95% CI 0.106-0.995. p-value=0.04). Conclusions Effectiveness of the COLO SSI prevention bundle is significant. A multidisciplinary approach to implement, evaluate and improve compliance with ISCR recommendations reduced COLO SSI SIR by 66%.
Databáze: OpenAIRE
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