Reducing surgical site infections after colectomy: bundle item compliance, process, and outlier identification

Autor: Anthony C. Antonacci, Christopher L. Antonacci, Samuel P. Dechario, Gregg Husk, Mary Ellen Schilling, Kelly Cifu-Tursellino, Donna Armellino, Gene Coppa, Mark Jarrett
Rok vydání: 2022
Předmět:
Zdroj: Surgical Endoscopy. 36:6049-6058
ISSN: 1432-2218
0930-2794
DOI: 10.1007/s00464-022-09234-6
Popis: The purpose of this study was to implement a checklist monitoring system and identify critical surgical checklist items associated with post-colectomy surgical site infections (SSI). The relationship between checklist compliance, infection rates, and identification of non-compliant surgeons was explored.National Health Safety Network (NHSN) data were imported annually to establish baseline incidence of post-colectomy SSI from 2016 to 2019. A colectomy checklist was used to monitor compliance for 1694 random colectomies (1274 elective; 420 emergency). Reports were generated monthly to profile system, hospital, surgeon-specific infection, and checklist compliance rates.Checklist compliance improved in elective and emergent colectomies to 90% for all items except oral antibiotic and mechanical bowel prep in elective cases. Annualized total SSI and organ space infection rates in elective cases decreased by 33% and 45%, respectively. Elective and emergency SSI's were reduced for Superficial Incisional Primary (SIP), Deep Incisional Primary (DIP), and Intra-Abdominal Abscess (IAB) by 66%, 60.4%, and 78.3%, respectively. Checklist compliance between low ( 3%) and high ( 3%) infection rate surgeons demonstrated significantly lower utilization of oral antibiotic prep (p 0.03) and mechanical bowel prep (p 0.02) in high infection rate surgeons.Surgeons compliant with colectomy checklists decreased elective and emergency colectomy infection rates. Ceiling compliance rates 95% for bundle items are suggested to achieve optimal reductions in SSIs and efforts should be focused on surgeons with NHSN infection rates 3%. Oral antibiotic prep and mechanical bowel prep compliance rates in elective colectomy appeared to differentiate high infection rate surgeons from low infection rate surgeons.
Databáze: OpenAIRE
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