Adjustments to an Existing Colorectal Surgical Site Infection Prevention Bundle Lead to Fewer Infections

Abstract

Background: Surgical site infections (SSI) related to colorectal procedures are detrimental to patients and publicly reportable events. Our institution implemented a successful bundle of interventions to decrease SSI rates in 2014. In 2018, compliance started to wane, with a concurrent increase in infections. In an effort to enhance compliance and incorporate up-to-date information, we convened a multidisciplinary team to streamline this process. Methods: Our team evaluated published studies on successful bundle components and updates to professional guidelines for SSI prevention to determine adjustments. Modifications included allowing surgeon preference for (rather than mandating) wound protector use and simplification of clean closure protocol (determined by intraoperative contamination, leading to more efficient closure time). In addition, measures were added to achieve perioperative patient optimization (maintenance of normothermia, prevention of intraoperative hypoxia, tighter glucose control and postoperative bathing). The bundle was implemented in stages starting January 2019. SSI rates were monitored throughout the process using NHSN definitions, and rates were compared using χ2 analysis (Epi Info, CDC). Results: From 2015 to 2017, bundle compliance was 90%, and 8 SSIs (rate, 3.8 per 100 procedures) were detected (Table 1). In 2018, compliance was 82%, with 4 SSIs (rate, 6.6 per 100 procedures). From January through September 2019, SSI rates decreased to a rate of 4.8 per 100 procedures, with notable increase in superficial SSI, with zero cases of deep or organ-space infections. Feedback from operating-room personnel indicated their commitment to bundle compliance and perceived intraoperative time savings. Conclusions: Revamping an existing colorectal SSI bundle, including relaxation of time-intensive and expensive intraoperative measures and increased focus on evidence-based guidelines, resulted in decreased deep-organ space SSI rates, as well as increased satisfaction from procedural team members. Successful implementation of care pathways to prevent infections is an iterative process and requires the engagement of practitioners.Funding: NoneDisclosures: None