WTP4.5 An Evaluation of the Introduction of a Perioperative Care Bundle to Reduce Surgical Site Infections after Bowel Resection Surgery in a DGH Setting

Abstract

Abstract Background The surgical site infection (SSI) rate for colonic resections at a District General Hospital (DGH) in South-Central England was 25.3%. The UK national average is 8.6%. The aim of this study was to evaluate if the implementation of a perioperative care bundle based on NICE guidance improved SSI rates. Methods Retrospective data was collected prior to the bundle implementation (Group 1) and prospective data following bundle introduction (Group 2). Inclusion criteria were all emergency and elective bowel resections. The primary outcome assessed was the development of an SSI within the 30-day postoperative period. The secondary outcomes were related to confounding variables, such as diabetes and immunosupression. Data was collected from the electronic patient record system and follow-up telephone consultations using a standardised questionnaire. Results The SSI rate in Group 1 (n=55) was 30.9% (95% CI,19.0%-43.1%) as opposed to 19.2% (95 CI, 8.5%-30.0%) in Group 2 (n=52), p=0.16. Interestingly, for patients of a BMI >30 the SSI rate dropped from 45.5% (95% CI, 16.7%-76.6%) to 20.0% (95% CI, 4.3%- 48.1%). Conclusion The 10-step perioperative care bundle did not significantly reduce the SSI rate. However, bundle uptake was moderate (73%), and only 65.4% of prospective cases achieved complete bundle compliance. Further research is required to investigate the effectiveness of this bundle on high-risk groups, as well as implementation barriers.