SP1.3 Implementation of a care bundle to sustainably reduce surgical site infection after emergency laparotomy

Abstract

Abstract Introduction Surgical site infection (SSI) after emergency laparotomy (EL) is reported in up to 35% of patients. Implementation of the PreciSSIon bundle; 2% chlorhexidine preparation, second-dose antibiotics after 4 hours operating, wound protector (WP), antibacterial sutures for deep and superficial layers, halved SSI after elective colorectal surgery. This project aimed to implement an adapted bundle for EL. Method For patients in hospital at 30 days, notes were reviewed. For those discharged before 30 days patient-reported 30-day SSI was measured using the Public Health England Questionnaire. Baseline data was collected for 1 year with bundle implemented 2020. Additions to bundle were glove change and betadine wound wash. Results 677 patients had EL over 4 years. Average mortality was 10%. A further 10% had laparostomy and temporary VAC dressing. Average response rate to questionnaire was 71%. Compliance with bundle elements were 100% for chlorhexidine, 96% for antibiotic 2nd dose, 83% and 90% for deep and superficial antibacterial sutures, 85% for glove change and betadine. Use of WPs was only 50%. After implementation of the bundle at the beginning of 2020, both patient-reported and in-patient SSI reduced, and total SSI has halved. Conclusion We have demonstrated reliable implementation of a care bundle (excluding WPs) sustainably reduced SSI after emergency laparotomy.