Effect of colon care bundle on surgical site infections in colorectal surgery

Abstract

Objectives: Surgical site infection (SSI) has been recognized as the third most common health-care-associated infection. Colorectal surgeries are consistently associated with higher SSI (4%–45%) relative to other surgeries. SSI not only increases morbidity but also causes severe economic impact throughout the world. The aim of the present study was to study the effect of colon care bundle on SSI and identify the risk factors involved in SSI in colorectal surgeries. Methods: Two hundred and seventy patients who underwent elective colorectal surgery between July 2015 and June 2017 were included in the study. Patients were assigned to bundle care group (n = 150) and control group (n = 122). In the colon care bundle group, patients received aseptic cleaning of skin with chlorhexidine (night before and morning), clipping of hair before surgery, nonabsorbable oral antimicrobial agents, maintenance of normothermia during surgery, and high-inspired oxygen intra- and postoperatively. Both groups received parenteral antibiotics for 24 h. SSI was defined as per the Centers for Disease Control and Prevention. Patients were followed for 30 days postoperatively. Results: Both groups were comparable with respect to age, gender, comorbidities, obesity, and other variables. SSI in the colon care bundle group (8.7%; n = 13) was less than in the control group (18.9%; n = 23), which was statistically significant (P = 0.014); however, effect on deep and organ/space infection was not statistically significant. The incidence of SSI increases with age and superficial SSIs were more common than deep or organ/space infection in both groups. SSIs were more common in wounds of rectal surgeries than colon surgeries (46% vs. 15%, P = 0.926). SSIs were more common in patients with diabetes mellitus (39.1% vs. 23.1%), patients with increased body mass index (BMI) (43.5% vs. 38.5%), patients with decreased serum albumin (69.6% vs. 53.8%), smokers (60.9% vs. 53.8%), and patients with preoperative chemoradiation (65.2% vs. 61.5%) in both groups (control group vs. bundle group), but did not reach statistical significance. Out of 36 SSIs in two groups, 24 were culture positive with Escherichia coli, followed by Enterococcus faecalis as common organisms. Conclusion: Colon care bundle is an effective method of reducing SSI in colorectal patients. Overall SSI was found to be significantly less in the study group than in controls. On subanalysis, superficial SSI was seen more in the control group. The infections were seen more often in diabetics; smokers; and patients with increased BMI, decreased serum albumin, preoperative chemoradiation, and rectal operations, though statistically not significant. However, efficacy of individual component of care bundle on SSI remains unanswered.