Abstract
BackgroundIn 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and ‘hygiene discipline’ in the operating room (i.e. number of door movements). Dutch hospitals were advised to implement the bundle and to measure the outcome. This study’s goal was to assess how effective the bundle was in reducing SSI risk.MethodsHospitals assessed whether their staff complied with each of the bundle elements and voluntary reported compliance data to the national SSI surveillance network (PREZIES). From PREZIES data, we selected data from 2009 to 2014 relating to 13 types of surgical procedures. We excluded surgeries with missing (non)compliance data, and calculated for each remaining surgery with reported (non)compliance data the level of compliance with the bundle (that is, being compliant with 0, 1, 2, 3, or 4 of the elements). Subsequently, we used this level of compliance to assess the effect of bundle compliance on the SSI risk, using multilevel logistic regression techniques.Results217 489 surgeries were included, of which 62 486 surgeries (29%) had complete bundle reporting. Within this group, the SSI risk was significantly lower for surgeries with complete bundle compliance compared to surgeries with lower compliance levels. Odds ratios ranged from 0.63 to 0.86 (risk reduction of 14% to 37%), while a 13% risk reduction was demonstrated for each point increase in compliance-level. Sensitivity analysis indicated that due to analysing reported bundles only, we probably underestimated the total effect of implementing the bundle.ConclusionsThis study demonstrated that adhering to a surgical care bundle significantly reduced the risk of SSIs. Reporting of and compliance with the bundle compliance can, however, still be improved. Therefore an even greater effect might be achieved.
Highlights
In the last decade, much more attention has been paid internationally to Patient Safety and Infection Prevention
This study demonstrated that adhering to a surgical care bundle significantly reduced the risk of Surgical Site Infections (SSIs)
We excluded cardiovascular surgeries (CAR, n = 13 736) because for this specialty it was impossible to meet the primary outcome as the bundle element hygiene discipline was not implemented for this specialty
Summary
Much more attention has been paid internationally to Patient Safety and Infection Prevention This was reflected in the Netherlands, where in 2007 a nationwide study was performed to quantify the amount of preventable complications and mortalities occurring in hospitals. This resulted in the formulation of a list of ten highly preventable complications, one of which was Surgical Site Infections (SSIs) [1]. The experts selected four practices (elements) to be included in the SSI bundle of care (see Table 1): the appropriate administration of antibiotic prophylaxis (if indicated) according to local guidelines, no preoperative surgical site hair removal, perioperative normothermia, and exercising ‘hygiene discipline’ in the operating room. This study’s goal was to assess how effective the bundle was in reducing SSI risk
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