Abstract
AimSurgical site infections (SSIs) are a preventable cause of morbidity following surgical procedures. Strategies to reduce rates of SSI must address pre‐, peri‐ and postoperative factors and multiple interventions can be combined into ‘bundles’. Adoption of these measures can reduce SSIs, but this is dependent on high levels of compliance. The aim of this work is to assess the change in rates of SSI in elective colorectal surgery after implementing a colorectal SSI bundle.MethodThis is a single‐centre prospective cohort study. All elective colorectal procedures from 2011 until 2018 (inclusive) were included. The primary outcome was inpatient SSI. A multimodal bundle was implemented using quality improvement methodology. The bundle was altered during the timeframe of the study to optimize outcomes. Data were analysed by interrupted time series analysis assessing points at which the bundle was altered.ResultsIn the study period, 1075 elective colorectal procedures were performed. Prior to the introduction of the colorectal SSI bundle, the SSI rate was 16.4%. During the implementation period (2013–2015), the overall rate of SSI fell from 15.9% to 9.4%, with the most significant reduction being in superficial SSI, from 8.6% to 4.7%. In the postimplementation period from 2015–2018, there was a further reduction in the overall rate of SSI (5.1%). In 2018, there were 87 consecutive cases without infection.ConclusionA successful reduction in the rate of SSI following elective colorectal surgery can be achieved by adopting a comprehensive perioperative bundle. This is complemented by a process of continuous measurement and evaluation. The current bundle has achieved a significant reduction in superficial SSI.
Highlights
The colon contains approximately 1014 live luminal bacteria, including multiple human pathogens [1]
Single-centre cohort study, we observed a significant reduction in surgical site infection (SSI) in patients undergoing elective colorectal resection over time
The overall SSI rate decreased from 16.4% in the first year of the study to 5.1% in the last, following the implementation of a comprehensive SSI bundle
Summary
The colon contains approximately 1014 live luminal bacteria, including multiple human pathogens [1]. SSIs are the most common cause of healthcare-associated infections (HAIs) and confer an additional morbidity and mortality to the surgical procedure originally performed. SSIs can contribute to a prolonged hospital stay and increased readmission and intervention rates. They can delay rehabilitation and a return to normal activity, which may have a significant psychological impact [6]. SSIs confer an additional 3% risk of mortality after colorectal resection [3]. This is significant, given that colorectal resection is a common elective procedure in the UK (n = 18,796 in 2019) [7]. SSIs have a substantial economic burden, with an associated 35% increase in direct healthcare costs [8,9]
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