Surgical Site Infection Prevention Bundle Research Articles

Surgical site infection prevention bundles: a focus on preoperative skin decolonisation

Surgical site infection prevention bundles: a focus on preoperative skin decolonisation

Wound infection prevention strategies in colorectal endoscopic mucosal resection: A meta-analysis of prophylactic measures.

Colorectal endoscopic mucosal resection (EMR) is associated with the risk of postoperative wound infections, prompting investigations into effective prophylactic measures. This meta-analysis aimed to evaluate the efficacy of various prophylactic interventions in reducing the incidence of wound infections following EMR. Adhering to PRISMA guidelines, we conducted a comprehensive search across multiple databases for randomized controlled trials (RCTs) and cohort studies from 2015 to 2022. We included studies that compared the efficacy of antibiotic prophylaxis and antiseptic measures, with clear data on post-procedure infection rates. Eight studies met our inclusion criteria, and data were extracted for meta-analysis. The risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. The meta-analysis included 3765 patients from eight RCTs. Prophylactic antibiotics (cefixime and cefuroxime) showed moderate to high efficacy, with infection rates as low as 0% and 0.76%. Prophylactic endoscopic closure and clipping showed the highest efficacy, with zero reported infections. The standardized surgical site infection prevention bundle had lower effectiveness, with an infection incidence of 3.83%. The risk of bias assessment indicated potential performance bias due to lack of blinding, but overall evidence quality was upheld by proper random sequence generation and diligent outcome data monitoring. The effectiveness of specific prophylactic measures, notably prophylactic antibiotics and mechanical closure techniques, has been shown in significantly reducing the risk of wound infections following colorectal EMR.

Surgical Site Infection Prevention Using "Strike Teams": The Experience of an Academic Colorectal Surgical Department.

Surgical site infections (SSIs) are healthcare-acquired infections with substantial morbidity. Surgical site infection persist because of low adherence to prevention bundles comprising multiple infection control elements. We propose the "Strike Team" as an implementation strategy to improve adherence and reduce SSI in colorectal surgery. At an academic medical center, a multidisciplinary Strike Team met monthly to review colorectal SSI cases, audit and discuss barriers to adherence to SSI prevention bundle, and propose actionable feedback. The latter was shared with frontline clinicians by the Strike Team's surgical leaders in everyday practice. Colorectal SSI rates and bundle adherence data were disseminated quarterly via the hospital intranet and reviewed with surgeons at departmental meetings. Trends in adherence and SSI rates were analyzed by regression analysis using a time series model. While the Strike Team was active, adherence to antibiotic prophylaxis, maintenance of normoglycemia, and standardized intraoperative skin preparation significantly increased (p < .05). There was a trend toward statistically significant reduction in SSI (p = .07), although it was not maintained once the Strike Team activity was disrupted by the COVID-19 pandemic. Colorectal SSI prevention requires a resource-intensive, multidisciplinary approach with numerous strategies to improve adherence to infection control bundles, as illustrated by our SSI Strike Team experience.

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany

1460. Assessing the impact of a surgical site infection prevention bundle on open reduction of fracture

Abstract Background In our hospital, risk of surgical site infection (SSI) after orthopaedic procedures varies approximately from 1% to 9% (Fig. 1). The objective of this study was to estimate the impact of a SSI prevention Bundle on the fracture-related infection (FRI) rates.Figure 1Surgical site infection (SSI) risk after orthopaedic procedures. Hospital Universitário Ciências Médicas (HUCM), Jan/2018 to Dec/2022. Methods This is a single-center retrospective cohort study carried out between Jan/2021 and Dec/2022, which included patients undergoing any type of orthopaedic surgery for bone stabilization due to open fracture in a tertiary specialized public hospital in Belo Horizonte, a 3,000,000 inhabitants city from Brazil. Rates of SSI were assessed following implementing a Bundle that applied extended-spectrum antibiotics (cefuroxime with gentamicin) for prophylaxis towards patients at higher risk for postoperative SSI consisting of those with Charlson's comorbidity index score ≥ 5 and/or preoperative hospitalization longer than five days; intraoperative redosing of antibiotics for surgeries longer than 3 hours; carry out intraoperative rechecks, auditing surgical procedures using the infection prevention control team, and reinforcing good practices in the operating room (Fig. 2). The pre-intervention (Jan/2021 to Mar/2022) and post-intervention period (Apr/2022 to Dec/2022) were compared. Categorical variables were compared using the chi-square test, and continuous variables using the t-student test, considering a significance level of 5%. SSI risk and protective factors were identified by univariate, and multivariate analysis by logistic regression.Figure 2Surgical site infection prevention bundle. Hospital Universitário Ciências Médicas (HUCM), Apr/2022 to Dec/2022. Results 1,901 patients were included and analyzed: 1,037 and 864 were included in the “pre-intervention bundles” group and “post-intervention bundles” group, respectively. Rates of SSI in the “pre-intervention bundles” group and “post-intervention bundles” group were 6.9% (72/1037) and 2.8% (24/864), respectively (p&amp;lt;0.001). The overall risk for FRI following the intervention bundle dropped by 59% (Fig. 3). In a multivariate analysis, the relative risk of FRI after the Bundle implementation was 0.4 (Figs. 4, 5).Figure 3Quarterly SSI rate after open reduction of fracture. Hospital Universitário Ciências Médicas (HUCM), Jan/2021 to Dec/2022.Figure 4Logistic model for SSI after open reduction of fracture. Hospital Universitário Ciências Médicas (HUCM), Jan/2021 to Dec/2022.Figure 5ROC curve for the logistic model for SSI after open reduction of fracture. Hospital Universitário Ciências Médicas (HUCM), Jan/2021 to Dec/2022. Conclusion The Bundle strategy implemented was effective in reducing the rates of FRI. These simple and affordable measures are suitable to be applied and replicated in low-income specialized public orthopaedic centers. Disclosures All Authors: No reported disclosures

Implementation of a Colorectal Surgical Site Infection Prevention Bundle and Checklist: A Quality Improvement Project.

After noting an elevated surgical site infection rate in 2019 associated with colorectal surgeries, leaders at two Central Virginia health system hospitals convened an interdisciplinary team to audit current practices and research infection prevention strategies. After identifying a lack of standardization in care processes for colorectal surgery patients and reviewing the literature on colorectal bundles, the team created a bundle focusing on the use of antibiotics, chlorhexidine gluconate wipes or baths, separate closing instrument trays, nasal decolonization, bowel preparation, and maintaining patient normothermia. After synthesis and stakeholder input, the team implemented the colorectal bundle along with a checklist for all users to complete to ensure compliance and standardization of practice and for auditing purposes. Implementation results were positive: the total number of colorectal infections decreased from nine in 2020 to three in 2021. Education was critical to securing staff member engagement for successful implementation of and compliance with the bundle.

Implementation of a Surgical Site Infection Prevention Bundle at the Time of Cesarean

Surgical site infection (SSI) prevention bundles have been associated with a reduction in SSI rates. SSI at the time of cesarean birth increases maternal morbidity and mortality, decreases patient satisfaction, and significantly increases hospital costs. Prior to implementation, there was no consistent SSI-prevention interventions.

NO BUGS: Nosocomial operative best-practices for unplanned infections in gynecologic surgery: A 6-month retrospective.

e18765 Background: An estimated 94,000 women have newly diagnosed gynecologic cancer (ovarian, uterine, cervical, and vulvovaginal) annually–with rates increasing over the last 20 years. Surgical site infections (SSIs) complicate up to 4% of all hysterectomies in the United States. Other surgical sequelae, such as operative length, estimated blood loss, wound dehiscence, and 30-day readmission, further complicate the post-surgical course of this vulnerable population. Methods: A quality improvement initiative was conducted in a large academic health system between January to June 2022 to investigate whether implementing an SSI bundle, defined as a set of 11 evidence-based practices performed collaboratively, can reduce intraoperative and postoperative complications. The study population included women who received gynecologic oncologic surgery. To evaluate trends following the implementation of an SSI prevention bundle, we studied two time periods: 1/1/22-3/31/22 and 4/1/22-6/30/22. Trends were analyzed using chi-squared and a two-sample t-test. Results: Over our six-month study period, 233 patients underwent primary gynecologic oncologic surgery. Robotic-assisted hysterectomies were the most common (27.89%, n = 65), followed by total abdominal hysterectomies (21%, n = 49), laparoscopic hysterectomies (7.72%, n = 18), and supracervical hysterectomies (3%, n = 7). An invasive, abdominal approach was needed for less than half of the surgeries for whom intraoperative and postoperative outcomes were measured (46.35%, n = 108). Following the implementation of our SSI bundle, there was a rise in estimated blood loss (134.49 to 252.67 mL), operative length (199.24 to 227.23 min), and length of stay (1.58 to 2.20 days). Yet, there was a decline in the SSI rate from 4.62% to 3.7% (p = 0.97) and 30-day all-cause readmission from 12.96% to 7.4% (p &lt; 0.05). The overall incidence of 30-day wound dehiscence also declined over six months from 3.7% to 1.85% (p = 0.74). Upon intersectional analysis, patients with SSI were older (55.93 vs. 62, p = 0.39) and were more likely to be obese (BMI 27.04 vs. 31.06, p &lt; 0.05). Individuals with functional status limitations, ECOG score &gt; 2, had longer lengths of stays (4.7 vs. 1.76 days, p &lt; 0.05), estimated blood loss (230 vs. 185.9 mL, p = 0.12), and operative length (374 vs. 205.2 min, p &lt; 0.001). Those with a supracervical hysterectomy also had a longer length of stays (4 days, p &lt; 0.05), blood loss (921.43 mL, p &lt; 0.001), and operative lengths (315.14 min, p &lt; 0.001). Conclusions: Following the implementation of an evidence-based SSI quality improvement project, cancer patients had fewer SSI, hospital readmissions, and wound dehiscence. High ECOG scores, supracervical hysterectomies, and obesity were all associated with worse postoperative outcomes. Prospective studies on postoperative surgical quality are needed to improve care for our most vulnerable patients.

Aiming for zero: success of the hysterectomy surgical site infection prevention bundle

Aiming for zero: success of the hysterectomy surgical site infection prevention bundle

SG-APSIC1207: Effectiveness of a surgical-site infection bundle in reducing postoperative infection in cesarean deliveries in a tertiary-care teaching hospital in Malaysia

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

The Role of the Gut Microbiome on the Development of Surgical Site Infections.

Despite advances in antisepsis techniques, surgical site infection remains the most common and most costly reason for hospital readmission after surgery. Wound infections are conventionally thought to be directly caused by wound contamination. However, despite strict adherence to surgical site infection prevention techniques and bundles, these infections continue to occur at high rates. The contaminant theory of surgical site infection fails to predict and explain most postoperative infections and still remains unproven. In this article we provide evidence that the process of surgical site infection development is far more complex than what can be explained by simple bacterial contamination and hosts' ability to clear the contaminating pathogen. We show a link between the intestinal microbiome and distant surgical site infections, even in the absence of intestinal barrier breach. We discuss the Trojan-horse mechanisms by which surgical wounds may become seeded by pathogens from within one's own body and the contingencies that need to be met for an infection to develop.

Getting it right first time: national survey of surgical site infection 2019.

Surgical site infections (SSIs) are associated with increased morbidity and mortality. Deep SSI, or prosthetic joint infection (PJI), is associated with revision surgery involving longer operative times with higher infection rates, longer length of stay (LoS) and high costs in addition to the catastrophic effect on the patient. The surveillance of SSI is important for patient decision making, identification of outliers for support and maximising focussed improvement. This paper reports the findings of the second Getting it Right First Time (GIRFT) national SSI survey for orthopaedic and spinal surgery. Data were submitted prospectively by 67 orthopaedic units and 22 spinal units between 1 May 2019 and 31 October 2019. For a patient to be included, they had to present with SSI within the study period and within 1 year of the index procedure. A total of 309 SSIs were reported from primary and revision, total hip, knee, shoulder, elbow and ankle replacements, and 58 SSIs were reported from lumbar spine single level discectomy or decompression, lumbar spine single-level instrumented posterior fusion, posterior cervical spine decompression and instrumented fusion and posterior correction of adolescent idiopathic scoliosis. SSIs rates have remained low compared with the 2017 survey. There were variations in SSI rates by procedure, with primary shoulder replacement reporting the lowest (0.4%) and revision shoulder replacement the highest (2.5%) rates. The authors recommend that the elective surgical restart following the COVID-19 pandemic provides a unique opportunity for all units to implement a full SSI prevention bundle to minimise the risk of infection and improve patient outcomes.

Determining Hospital Cost for Postoperative Complications: A Strategy to Drive Investment into Your Colorectal Surgery Quality Improvement Program

INTRODUCTION: Postoperative complication (POC) significantly increase healthcare cost. Identifying sources of cost variation helps implement or justify quality improvement programs. This study focuses on the incidence and POC cost after colorectal surgery (CRS). METHODS: Institutional data using the American College of Surgeons NSQIP was queried from 2013 to 2019 for patients undergoing CRS and merged with our financial database. Incidence of NSQIP-defined POC was determined in addition to index hospitalization (IHC) and 30-day post-discharge direct cost (PDCC). PDCC includes labs, imaging, clinic visits, readmission, and emergency department visits to our institution. RESULTS: A total of 2233 patients were identified, with 23.9% experiencing a POC resulting in a 1.5-4.5-fold increase in IHC and 2-15-fold increase in PDCC compared with patients who experienced no POCs. Each complication led to a significant increase in IHC/PDCC cost (p < 0.001). Most of these patients experienced one POC (N = 307, 13.7%) but the remaining experienced 2-6 POCs (N = 227, 10.1%). Anastomotic leak occurred in 5.5% (N = 123) of cases and were categorized by treatment: reoperation (N = 63), nonoperative intervention, ie percutaneous or endoscopic (N = 35), or no intervention (N = 25). All treated leaks resulted in additional significant IHC/PDCC (p <0.001). Overall rate of readmission was 10.5% and unplanned reoperation was 8.0% (Table). CONCLUSION: POC after CRS is common and adds a significant healthcare, cost both during the index hospitalization and post-discharge. This underscores the importance of and should justify investment in enhanced recovery programs, surgical site infection prevention bundles, and prehabilitation programs, which can mitigate the occurrence of many of the POCs considered. Table. - NSQIP Complication and Cost after Colorectal Surgery Characteristic N Incidence Mean index of hospitalization cost Mean 30-day post-discharge cost All Patients 2233 $27,123 ± 31,428 $3,127 ± 13,752 No Postoperative Complication 1699 76.1% $19,424 ± 12,158 $1,352 ± 5,503 Post Operative Complication(s) 534 23.9% $51,620 ± 53,621 $8,774 ± 25,563 Deep SSI 51 2.3% $49,885 ± 50,417 $21,747 ± 43,915 Organ/Space SSI 125 5.6% $54,832 ± 54,065 $13,448 ± 21,045 Sepsis 103 4.6% $40,455 ± 34,456 $7,286 ± 12,608 Respiratory Failure 184 8.2% $85,807 ± 64,197 $10,142 ± 34,231 Prolonged NPO/NGT Use aka “ileus” 494 22.1% $48,153 ± 49,561 $7,701 ± 26,274 Anastomotic Leak treated with Reoperation 63 2.8% $83,344 ± 82,075 $20,340 ± 33,018

Are Kids More Than Just Little Adults? A Comparison of Surgical Outcomes

IntroductionWhile complication rates have been well described using the National Surgical Quality Improvement Program (NSQIP) and National Surgical Quality Improvement Program–Pediatric registries, there have been no direct comparisons of outcomes between adults and children. Our objective was to describe differences in postoperative outcomes between children and adults undergoing common surgical procedures. MethodsUsing data from 2013 to 2017, we identified patients undergoing laparoscopic appendectomy, laparoscopic cholecystectomy, thyroidectomy, and colectomy. Propensity score matching on gender, race, American Society of Anesthesiologists class, surgical indication, and procedure type was performed. Outcomes included surgical site infection (SSI), readmission rates, mortality/serious morbidity, and hospital length of stay and were analyzed using χ2 and student's t-test with statistical significance defined as P < 0.05. ResultsWe matched 79,866 patients from 812 hospitals. Compared to adults, children had higher rates of SSI following appendectomy (4.12% versus 1.40%, P < 0.01) and cholecystectomy (0.96% versus 0.66%, P = 0.04), readmission following appendectomy (4.26% versus 2.47%, P < 0.01), and longer length of stay in all procedures. In adults, 30-day mortality/serious morbidity was higher for all procedures. ConclusionsCompared to adults, children demonstrate unique surgical complication and outcome profiles. Quality improvement efforts such as SSI prevention bundles and enhanced recovery protocols used in adults should be expanded to children.

The Strike Team as an implementation strategy for surgical infection prevention

Background: Surgical site infections (SSIs) incur up to $10 billion annually due to their excessive morbidity. SSI prevention bundles have had variable success in colorectal surgery. For example, at the University of Wisconsin Hospital, a 505-bed regional referral center, SSI rates have remained high despite the introduction of a 14-element SSI prevention bundle in 2016. To aid in the implementation of this complex bundle, the hospital started Strike Teams in 2019. We have described the impact of Strike Teams on colorectal SSI rates in our tertiary-care hospital. Methods: A Strike Team with key stakeholders from colorectal surgery (ie, surgeon, OR director, nurses, surgical technicians), anesthesia, pharmacy, infection prevention, and infectious disease was formed, supported by the hospital’s executive leadership. The Strike Team met monthly throughout 2019 to review each SSI case, discussed barriers to adherence for the SSI prevention bundle elements with implementation difficulties (Table 1), and proposed actionable feedback to increase adherence. The latter was disseminated to frontline clinicians by the teams’ surgical leaders during everyday clinical practice. The Strike Team was paused in 2020 due to resource reallocation in response to the COVID-19 pandemic. Monthly and quarterly SSI surveillance was conducted according to CDC guidance. Results: Colorectal SSI rates before, after, and during Strike Team activity are shown in Fig. 1. Adherence rates to the bundle elements targeted by the Strike Team are shown in Fig. 2. Conclusions: Adherence to the preferred antibiotic prophylaxis increased, although adherence to other bundle elements of focus did not change significantly. SSI rates decreased below our expectation while the Strike Team was active in our hospital, although SSI reduction was not sustained. Further research should study the effectiveness of Strike Teams as a long-term implementation strategy for SSI prevention in colorectal surgery.Funding: NoneDisclosures: None

MP25-18 SEPARATE ABDOMINAL CLOSURE TRAYS SIGNIFICANTLY IMPROVE CYSTECTOMY SURGICAL SITE INFECTION; OUTCOMES FROM A PRE-POST IMPLEMENTATION NATIONAL SURGICAL QUALITY INPATIENT PROGRAM (NSQIP) PROJECT

You have accessJournal of UrologyCME1 May 2022MP25-18 SEPARATE ABDOMINAL CLOSURE TRAYS SIGNIFICANTLY IMPROVE CYSTECTOMY SURGICAL SITE INFECTION; OUTCOMES FROM A PRE-POST IMPLEMENTATION NATIONAL SURGICAL QUALITY INPATIENT PROGRAM (NSQIP) PROJECT Kevin Krughoff, Christopher Mantyh, Charles D. Scales, and Andrew C. Peterson Kevin KrughoffKevin Krughoff More articles by this author , Christopher MantyhChristopher Mantyh More articles by this author , Charles D. ScalesCharles D. Scales More articles by this author , and Andrew C. PetersonAndrew C. Peterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While surgical site infection (SSI) prevention bundles have gained popularity across many disciplines, the urologic experience remains underreported. Our goal was to assess the impact of an abdominal closure protocol (ACP) on the incidence of SSI, UTI and procedure duration for cystectomy with urinary diversion. METHODS: A standardized abdominal closure protocol (ACP) was adopted at our institution in 2021 which included re-prep and re-drape of the abdomen, change of surgeon gowns and gloves and utilization of a separate abdominal closure tray. Utilizing the National Surgical Quality Inpatient Program (NSQIP) database, patients who underwent cystectomy and urinary diversion between 2016-2021 were identified for assessment. Cases incorporating the ACP were matched to cases pre-dating the incorporation of the ACP through propensity score matching based on 16 NSQIP-derived predictor variables. The optimal matching algorithm was determined based on greatest resulting reductions in standardized mean differences and variance ratios between groups. Counterfactual outcomes were generated using logistic regression to determine the average treatment effect of ACP incorporation. Standard errors and the 95% confidence intervals were calculated from 1,000 bootstrap samples. RESULTS: A total of 327 cases at our facility were reviewed. Twenty-three of 24 ACP cases were successfully matched to 245 of 303 non-ACP cases using a kernel-matching algorithm (Figure 1). Matching resulted in standardized mean differences below 0.1 for 14 of 16 NSQIP predictor variables and variance ratios of less than 2.0 for all NSQIP predictor variables. Following ACP incorporation, there was a raw SSI reduction of 5.7%, a raw UTI reduction of 5.6% and a raw increase in procedure duration of 38.4 minutes. The estimated treatment effect after modeling was a 4.1% reduction in SSI (p<0.02, CI 0.6% to 7.5%), with no significant effect on UTI incidence or procedure duration. CONCLUSIONS: Using a treatment effects model, the incorporation of an abdominal closure protocol was associated with a significant reduction in surgical site infection with minimal increase in surgical time. Source of Funding: Boston Scientific Fellowship Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e435 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Krughoff More articles by this author Christopher Mantyh More articles by this author Charles D. Scales More articles by this author Andrew C. Peterson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Achieving Zero Coronary Artery Bypass Graft Surgical Site Infections for Over Four Years: Our Experience Utilizing Bundle Elements, Education, and Audits

To reduce coronary artery bypass graft (CABG) deep incisional and organ/space surgical site infection (SSI) incidences we established consistent use of SSI prevention bundle elements, education, and audits. These practices have helped us reduce and maintain zero CABG SSI incidences from October 2016-July 2021 at our hospital.

Implementing a surgical site infection prevention bundle for emergency appendectomy: Worth the effort or waste of time?

BackgroundThe aim of this study was to evaluate feasibility and impact of an intraoperative surgical site infection prevention bundle for emergency appendectomy. MethodsConsecutive adult patients undergoing emergency appendectomy were prospectively included during a 10-year study period (2011−2020). The care bundle was implemented as of November 1, 2018, and focused on 4 intraoperative items (disinfection, antibiotic prophylaxis, induction temperature control >36.5°C, and intracavity lavage). The primary outcome was the compliance to bundle items. Thirty-day surgical site infections were assessed by the independent Swiss National SSI Surveillance Program (2011 to October 2018) and by an institutional audit (November 2018−2020). Independent risk factors for surgical site infection were identified through multinominal logistic regression analysis. ResultsOf 1,901 patients, 449 (23.6%) were included after bundle implementation. Overall surgical site infection rate was 111 (5.8%). In 42 patients with surgical site infection (37.8%), antibiotic treatment alone was done, and additional surgical management was necessary in 31 patients (27.9%), computed tomography-guided drainage in 30 patients (27%), and bedside wound opening in 9 cases (8.1%). Overall compliance to the bundle was 79.9%. Overall surgical site infection rates were decreased after bundle implementation (17/449 [3.8%] vs 94/1,452 [6.5%], P = .038), mainly due to a decrease in superficial incisional infections (P = .014). Independent risk factors for surgical site infection were surgical duration ≥60 minutes (odds ratio: 1.66, P = .018), contamination class IV (odds ratio: 2.64, P < .001), and open or converted approach (odds ratio: 4.0, P < .001), and the bundle was an independent protective factor (odds ratio: 0.58, P = .048). ConclusionImplementation of an intraoperative surgical site infection prevention bundle was feasible and might have a beneficial impact on surgical site infection rates after emergency appendectomy.

Surgical site infection prevention bundle in elective colorectal surgery

Surgical Site Infections (SSIs) are responsible for a significant economic burden as well as intangible costs suffered by the patient, with up to 60% deemed preventable. Colorectal patients are disproportionally affected by SSI due the risk of wound contamination with bowel content. We aimed to reduce the rate of superficial SSI after elective colorectal surgery using a bundle of evidence-based interventions. An SSI prevention bundle was implemented in elective colorectal surgery, comprised of triclosan-coated sutures, 2% chlorhexidine skin preparation and use of warmed carbon dioxide (CO2) during laparoscopic procedures. The SSI reduction strategy was prospectively implemented and compared with historical controls. Our primary outcome measure was the overall rate of superficial SSI. Centres for Disease Control and Prevention criteria, which use microbiological evidence in conjunction with clinical features were used as the definition of SSI. The overall SSI rate was 27.4% in the pre-bundle group (N= 208) and 12.5% in the patients who received the SSI prevention bundle (N= 184) (adjusted odds ratio 0.38; confidence interval 0.21-0.67; P<0.001). The median time to SSI diagnosis was postoperative day 8. Overall patient length of stay (LOS) was unchanged from six days at baseline following implementation of the bundle. We have shown successful implementation of an SSI prevention bundle which has reduced superficial SSI rate. We recommend this SSI prevention bundle becomes standard practice in elective colorectal surgery and plan to extend the bundle to emergency general surgery.