Surgical Site Infection Bundle Research Articles

Surgical Site Infection Bundle for Babies – Preliminary Data

Introduction & Background: Perioperative care bundles reduce surgical site infections (SSIs) in adults but are not used regularly in infant surgery. Infections in babies after surgery are less common but carry significant morbidity in a fragile patient. Question & Significance/Aim: We aim to evaluate the effects of a perioperative care bundle in patients less than 6 months old undergoing abdominal or thoracic surgeries. Methods & Design: The perioperative bundle was developed in a multi-disciplinary fashion and addressed several areas of care: standardized bowel preparation when appropriate, preoperative skin cleansing, antibiotic choice and timing, temperature control, intraoperative skin preparation, and closing protocols. Patient characteristics and outcomes were compared pre- and post-implementation of the bundle. An SSI bundle checklist was used to help confirm bundle adherence. Results: After 6 months, 44 cases were reviewed with 26 pre- and 18 post-implementation. The median estimated gestational age at birth was 36.6 weeks (IQR 30.8, 37.6). The median weight at surgery was 3.3 kg (IQR 2.3, 4.0). After bundle implementation, we saw statistically significant increases in appropriate antibiotic timing (42.3% vs 77.8%, p=0.03), pre-operative skin cleansing (0.0% vs 61.1%, p<0.001), Chloraprep™ use (3.8% vs 61.1%, p<0.001), and closing protocols (0.0% vs 33.3%, p=0.0026). No difference in SSI was appreciated (Table 1). The bundle was used appropriately 83% of the time. Discussion: A perioperative SSI bundle in babies can change the approach to infection control during surgery. The rate of SSI in both groups was low. Adoption of our bundle was good, but we expect its use requires more patients to appreciate benefits.

Aiming for Zero: Success of the Hysterectomy Surgical Site Infection Prevention Bundle

Background: The Center for Disease Control’s National Healthcare Safety Network (NHSN) reported an increased Standardized Infection Ratio (SIR) at a large community hospital, calculated by the number of observed infections over the number of predicted infections. In response to the increased SIR, a multidisciplinary Hysterectomy Surgical Site Infection (SSI) Prevention Workgroup was formed in 2019. Objective: To promote a surgical site infection prevention bundle that was implemented at a large community hospital to reduce hysterectomy associated surgical site infections. Study Design: The Workgroup implemented an evidence-based Hysterectomy SSI Prevention Bundle which enforced standardization of measures and techniques at: The pre-operative clinic appointment, the day of surgery, the intra-operative time prior to incision, the intra-operative time from incision to closure, and in the immediate post-operative recovery. The Hysterectomy SSI Prevention Bundle was implemented November 2, 2020. This study included all hysterectomies for benign pathologies from 10/1/2018 to 9/30/2020 [pre-implementation (n=811)] and 1/1/2021 to 9/30/2022 [post-implementation (n=772)]. Per NHSN data categorization guidelines, a designation of abdominal hysterectomy includes both open and laparoscopic routes. Inpatient surgery was defined as that with a date of discharge different from date of operation; outpatient surgery was defined as the one with the same date of discharge. SSIs included superficial, deep and organ/space, while complex SSIs included deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. Results: After implementation of the SSI bundle, SIR for hysterectomies was reduced to < 1.0, indicating infection prevention. Outpatient abdominal hysterectomy SIR pre-implementation was 2.551 and post-implementation was 0.868 (p=0.007). The outpatient vaginal hysterectomy SIR pre-implementation was 0, and post-implementation remained 0 (p=0.364). Inpatient abdominal hysterectomy SIR pre-implementation was 1.554 and post-implementation was 0.443 (p=0.072). The inpatient vaginal hysterectomy SIR preimple-mentation was 1.064, and post-implementation was 0 (p <0.001). The inpatient complex abdominal hysterectomy SIR pre-implementation was 1.757 and post-implementation was 0 (p=0.040). The inpatient complex vaginal hysterectomy SIR pre-implementation was 1.001, and post-implementation was 0 (p <0.001). Differences between the pre- and post-implementation groups were significant for increased laparoscopic hysterectomies (p<0.001), decreased vaginal hysterectomies (p<0.001), increased number of same day discharges (p<0.001), longer procedure duration (p<0.001), and younger age (p=0.039). Conclusion: Implementation of an evidence-based surgical site infection prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.

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.

Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review.

To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. A scoping review. Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. Scoping Reviews (PRISMA-ScR) checklist. A health consumerinterpreted the data and prepared the manuscript.

Examining barriers to implementing a surgical-site infection bundle.

Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. Qualitative study. We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.

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.

Improving the Outcomes in Oncological Colorectal Surgery

Aim: To evaluate the improvement in the outcomes in oncological colorectal surgery. Study Design: Prospective study, Place &amp; duration of study: Department of General Surgery, LUMHS Jamshoro from 1st January 2020 to 31st December 2022. Methodology: One hundred and fifty cases of colorectal cancer undergoing surgery were enrolled. They were multidisciplinary requiring compliance of surgeons at the operating room with their surgical teams. These interventions were based on sequential implementation of the evidence-based surgical site infection bundle (SSIB) and enhanced recovery after surgery (ERAS) protocols for all the patients undergoing colorectal surgery. Primary outcomes evaluated were duration of hospital stay as well as rate of complication in accordance with wound healing. Inverse proportional-weighting method was used for controlling possible variance within groups. The secondary outcome measures post improvement strategies were mortality within day 30, readmission within same period (30 days) or unplanned return to the operating table as well as numerous related complications. Results: The mean age of the cases in group A (pre-ERAS or pre-SSIB) was 61.2±10.9 years while in group B (pre-ERAS or post-SSIB) was 61.8±9.9 years and the mean age of Group C (post-ERAS or post-SSIB) was 63.7±10.1 years. There were more females within three groups such as 60%, 56% and 54% respectively than males. Hospital stay was highest within group A. The 30 days outcomes showed that the outcomes in group A showed highest number of death, wound infection and blood transfusion however the difference was insignificant for all other variable except wound infection. Conclusion: The subsequent addition of quality improvement within groups added positive outcomes in patients of oncological colorectal surgery with reduction in mortality, hospital stay as well as wound infection. Key words: Outcome, Colorectal carcinoma, Mortality, Hospital stay, Wound infection

Association between Electronic Health Record Implementations and Hospital-Acquired Conditions in Pediatric Hospitals.

Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a network of 145+ children's hospitals that share data and protocols to reduce harm in pediatric care delivery, to study the impact of EHR implementations on patient safety. Determine if there is an association between the time immediately surrounding an EHR implementation and hospital-acquired conditions (HACs) rates in pediatrics. A survey of information technology leaders at pediatric institutions identified EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the SPS database to create an anonymized dataset of 27 sites comprising monthly HAC and care bundle compliance rates in the 7 months preceding and succeeding the transition. Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events, surgical site infections (SSIs), pressure injuries (PIs), and falls, in addition to four associated care bundle compliance rates: CLABSI and CAUTI maintenance bundles, SSI bundle, and PI bundle. To determine if there was a statistically significant association with EHR implementation, the observation period was divided into three eras: "before" (months -7 to -3), "during" (months -2 to +2), and "after" go-live (months +3 to +7). Average monthly HAC and bundle compliance rates were calculated across eras. Paired t-tests were performed to compare rates between the eras. No statistically significant increase in HAC rates or decrease in bundle compliance rates was observed across the EHR implementation eras. This multisite study detected no significant increase in HACs and no decrease in preventive care bundle compliance in the months surrounding an EHR implementation.

Cost and Quality: How Do Surgical Site Infection Bundles Measure Up?

Levy, Brittany MD; Wilt, Wesley MD; Hansen, Elizabeth Rose; Bhakta, Avinash Sukhdev MD, FACS; Davenport, Daniel; Patel, Jitesh A MD, FACS Author Information

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before–after study in operating theatres in the Netherlands

ObjectivesTo assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating...

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 EPIDEMIOLOGICAL DETERMINATION OF NOSOCOMIAL INFECTION IN INPATIENTS AT ADAM MALIK GENERAL HOSPITAL, MEDAN

&lt;pre&gt;&lt;strong&gt;Background&lt;/strong&gt;: Nosocomial infection is a complication that most often occurs in hospitals and other health services. Infection is a most widely acquired hospital effect that can affect 5 to 10% of all hospitalized patients in developed countries and in low-background countries being a major burden. &lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: This study aims to determine the epidemiological determinants of nosocomial infections in inpatients at the General Hospital of the Haji Adam Malik Center, Medan in 2019.&lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;Method&lt;/strong&gt;: Determination of the sample size in the case and control using unpaired categorical analitical formula obtained a total sampel of 90 patients with ratio of 1:1. Data analysis using chi-square test analysis. &lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;Result&lt;/strong&gt;: The results showed that the dominant type of infection was urinary tract infection (35.6%), the most widely used type of invasive procedure was catheters (35.6%), the most common type of germs was conditional pathogens (84.4%), and the most common type of invasive procedure was catheter treatment ≥ 7 days (64.4%). The determinants of nosocomial infection in hospitalized patients were the type of invasive action (surgery, p value 0.013 and length of stay of patients (≥ 7 days, p value 0.035). &lt;/pre&gt;&lt;pre&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Performing surgery in accordance with standart operational procedure, applying surgical site infection bundles, discharging surgery patients on the fourth day, improving personal hygiene, reducing invasivtione procedures and providing antimicrobials to patients are necessary to reduce the incidence of nosocomial infections.&lt;/pre&gt;

Association between Patient and Hospital Characteristics and Adherence to a Surgical Site Infection Reduction Bundle in a Statewide Surgical Quality Improvement Collaborative.

Adherence to bundled interventions can reduce surgical site infection (SSI) rates; however, predictors of successful implementation are poorly characterized. We studied the association of patient and hospital characteristics with adherence to a colorectal SSI reduction bundle across a statewide surgical collaborative. A 16-component colorectal SSI reduction bundle was introduced in 2016 across a statewide quality improvement collaborative. Bundle adherence was measured for patients who underwent colorectal operations at participating institutions. Multivariable mixed-effects logistic regression models were constructed to estimate associations of patient and hospital factors with bundle adherence and quantify sources of variation. Among 2,403 patients at 35 hospitals, a median of 11 of 16 (68.8%, interquartile range 8 to 13) bundle elements were completed. The likelihood of completing 11 or more elements was increased for obese patients (56.8% vs 51.5%, odds ratio [OR] 1.39, 95% CI 1.05 to 1.86, p = 0.022) but reduced for underweight patients (31.0% vs 51.5%, OR 0.51, 95% CI 0.26 to 1.00, p = 0.048) compared with patients with a normal BMI. Lower adherence was noted for patients treated at safety net hospitals (n = 9 hospitals, 24.4% vs 54.4%, OR 0.08, 95% CI 0.01 to 0.44, p = 0.004). The largest proportion of adherence variation was attributable to hospital factors for six bundle elements, surgeon factors for no elements, and patient factors for nine elements. Adherence to an SSI reduction bundle is associated with patient BMI and hospital safety net status. Quality improvement groups should consider institutional traits for optimal implementation of SSI bundles. Safety net hospitals may require additional focus to overcome unique implementation barriers.

Impact of preoperative nasopharyngeal cultures on surgical site infection after open heart surgery

ObjectivesDespite advances in surgical techniques and management, surgical site infection (SSI) is still important after cardiovascular surgery. We investigated to determine whether or not preoperative nasopharyngeal cultures (NCx) can predict SSI and its microbial spectrum. MethodsA retrospective review was done in 1226 consecutive patients undergoing NCx and cardiac and thoracic aortic surgery via median sternotomy who were cared for with the standard SSI bundle between 2013 and 2018. Microorganisms isolated from the NCx and SSI pathogens were counted to explore the microbial pattern and associated variables in patients with and without postoperative SSI. Perioperative management was not changed by collection of preoperative NCx. ResultsThere were 1281 and 127 microorganisms, including coagulase-negative Staphylococcus as the most prevalent, isolated from 784 nasal and 111 pharyngeal specimens, respectively. Postoperative SSI occurred in 31 patients (2.47%), including chest, groin, and leg SSI. Significant coincidence of the SSI pathogens with the NCx microorganisms was not observed. However, the patients with SSI showed significantly higher positive rates of preoperative NCx than those without SSI. The sensitivity/specificity of NCx for SSI were 81%/37% for nasal and 45%/92% for pharyngeal, respectively. The negative predictive value of NCx for ruling out SSI was 98.6% for nasal and 98.4% for pharyngeal, respectively. Independent risk factors for postoperative SSI included female sex, diabetes mellitus, positive preoperative NCx, and postoperative use of Portex Mini-Trach (Smiths Medical, Minneapolis, Minn) or tracheostomy on multivariate analysis. ConclusionsPreoperative NCx may be useful to predict SSI after open heart surgery via median sternotomy, as well as screening for methicillin-resistant Staphylococcus aureus.

Study of Visual and Aural Memory Characteristics Under Functional State Changing

The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presence of multiple standardized care programs provides additive benefit.Institutional ACS-NSQIP data were used to identify patients who underwent elective CRS from September 2006 to March 2013. The cohort was stratified into 3 groups relative to implementation of the ERP (February 1, 2010) and SSIB (July 1, 2011). Unadjusted characteristics and 30-day outcomes were assessed, and inverse proportional weighting was then used to determine the adjusted effect of these programs.There were 787 patients included: 337, 165, and 285 in the pre-ERP/SSIB, post-ERP/pre-SSIB, and post-ERP/SSIB periods, respectively. After inverse probability weighting (IPW) adjustment, groups were balanced with respect to patient and procedural characteristics considered. Compared with the pre-ERP/SSIB group, the post-ERP/pre-SSIB group had significantly reduced length of hospitalization (8.3 vs 6.6 days, p = 0.01) but did not differ with respect to postoperative wound complications and sepsis. Subsequent introduction of the SSIB then resulted in a significant decrease in superficial SSI (16.1% vs 6.3%, p < 0.01) and postoperative sepsis (11.2% vs 1.8%, p < 0.01). Finally, inflation-adjusted mean hospital cost for a CRS admission fell from $31,926 in 2008 to $22,044 in 2013 (p < 0.01).Sequential implementation of the ERP and SSIB provided incremental improvements in CRS outcomes while controlling hospital costs, supporting their combined use as an effective strategy toward improving the quality of patient care.

Reducing surgical site infection rates in colorectal surgery - a quality improvement approach to implementing a comprehensive bundle.

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.

Risk factors for pediatric surgical site infection following neurosurgical procedures for hydrocephalus: a retrospective single-center cohort study

BackgroundInfection is a major complication following cerebral spinal fluid (CSF) diversion procedures for hydrocephalus. However, pediatric risk factors for surgical site infection (SSI) are currently not well defined. Because a SSI prevention bundle is increasingly introduced, the purpose of this study was to evaluate risk factors associated with SSIs following CSF diversion surgeries following a SSI bundle at a single quaternary care pediatric hospital.MethodsWe performed a retrospective cohort study of patients undergoing CSF diversion procedures from 2017 to 2019. SSIs were identified prospectively through continuous surveillance. We performed unadjusted logistic regression analyses and univariate analyses to determine an association between SSIs and patient demographics, comorbidities and perioperative factors to identify independent risk factors for SSI.ResultsWe identified a total of 558 CSF diversion procedures with an overall SSI rate of 3.4%. The SSI rates for shunt, external ventricular drain (EVD) placement, and endoscopic third ventriculostomy (ETV) were 4.3, 6.9 and 0%, respectively. Among 323 shunt operations, receipt of clindamycin as perioperative prophylaxis and presence of cardiac disease were significantly associated with SSI (O.R. 4.99, 95% C.I. 1.27–19.70, p = 0.02 for the former, and O.R. 7.19, 95% C.I. 1.35–38.35, p = 0.02 for the latter). No risk factors for SSI were identified among 72 EVD procedures.ConclusionWe identified receipt of clindamycin as perioperative prophylaxis and the presence of cardiac disease as risk factors for SSI in shunt procedures. Cefazolin is recommended as a standard antibiotic for perioperative prophylaxis. Knowing that unsubstantiated beta-lactam allergy label is a significant medical problem, efforts should be made to clarify beta-lactam allergy status to maximize the number of patients who can receive cefazolin for prophylaxis before shunt placement. Further research is needed to elucidate the mechanism by which cardiac disease may increase SSI risk after shunt procedures.

Adjustments to an Existing Colorectal Surgical Site Infection Prevention Bundle Lead to Fewer Infections

Background: Surgical site infections (SSI) related to colorectal procedures are detrimental to patients and publicly reportable events. Our institution implemented a successful bundle of interventions to decrease SSI rates in 2014. In 2018, compliance started to wane, with a concurrent increase in infections. In an effort to enhance compliance and incorporate up-to-date information, we convened a multidisciplinary team to streamline this process. Methods: Our team evaluated published studies on successful bundle components and updates to professional guidelines for SSI prevention to determine adjustments. Modifications included allowing surgeon preference for (rather than mandating) wound protector use and simplification of clean closure protocol (determined by intraoperative contamination, leading to more efficient closure time). In addition, measures were added to achieve perioperative patient optimization (maintenance of normothermia, prevention of intraoperative hypoxia, tighter glucose control and postoperative bathing). The bundle was implemented in stages starting January 2019. SSI rates were monitored throughout the process using NHSN definitions, and rates were compared using χ2 analysis (Epi Info, CDC). Results: From 2015 to 2017, bundle compliance was 90%, and 8 SSIs (rate, 3.8 per 100 procedures) were detected (Table 1). In 2018, compliance was 82%, with 4 SSIs (rate, 6.6 per 100 procedures). From January through September 2019, SSI rates decreased to a rate of 4.8 per 100 procedures, with notable increase in superficial SSI, with zero cases of deep or organ-space infections. Feedback from operating-room personnel indicated their commitment to bundle compliance and perceived intraoperative time savings. Conclusions: Revamping an existing colorectal SSI bundle, including relaxation of time-intensive and expensive intraoperative measures and increased focus on evidence-based guidelines, resulted in decreased deep-organ space SSI rates, as well as increased satisfaction from procedural team members. Successful implementation of care pathways to prevent infections is an iterative process and requires the engagement of practitioners.Funding: NoneDisclosures: None

Improved Postoperative Outcomes By Utilizing A Comprehensive Perioperative Surgical Site Infection (SSI) Reduction Bundle

Background: Surgical site infections (SSIs) can be attributed to increased patient morbidity and mortality, prolonged hospital stays, and overall increased healthcare costs. The Surgical Care Improvement Project (SCIP) was implemented in 2002 but has made limited impact on SSI rates across our facilities, which has led to the creation of a bundled approach of current evidence-based strategies. Methods: In January 2019, a comprehensive SSI prevention bundle of strategies was implemented across a multihospital health system. The bundle was comprised of 8 interventions focusing on the preoperative, intraoperative, and postoperative continuum of care, and refining documentation in the electronic medical record. From January to September 2019 (preointervention period), data were collected from 7,163 adult inpatient and observation elective patients undergoing colon surgery (COLO), abdominal hysterectomy (HYST), hip arthroplasty (HPRO), knee arthroplasty (KPRO), and cardiac bypass graft (CBGB/CBGC). The preintervention period for SSI standardized infection ratios (SIRs) and retrospective review of process measures was set as January–December 2018 (postintervetnion period). Each process measure had outlined targets along with primary outcome measures of overall SSI SIRs and SIRs for each of the 5 reported procedure categories. SSIs were validated to meet CDC and NHSN surveillance case definitions. Secondary outcomes evaluated included length of stay (LOS), readmission rates, and mortality. Results: Overall SIR for all 5 monitored surgical categories decreased by 5% to 1.131 from January to September 2019, compared to SIR of 1.190 in 2018. Hip and knee arthroplasties demonstrated 40% and 38% reductions after the intervention, respectively. Completion of 7 or 8 interventions of the SSI bundle were correlated with lower readmission rates (P = .0488). When any portion of the bundle was used, this was correlated with shorter LOS (P &lt; .0001). Adherence to standardized antimicrobial prophylaxis was associated with decreased mortality (P = .017), for all 5 surgical categories. Conclusions: With the implementation of a focused SSI reduction bundle, our institution has realized reductions in surgical readmissions, length of stay, and mortality. Additionally, SSI rates in certain procedure categories have shown marked improvement. The initial success of this bundle has garnered development of additional procedure focused supplemental strategies for the future year.Funding: NoneDisclosures: Aarikha D’Souza, Banner Health

Effectiveness of Preventive Surgical Site Infection Bundle in Colorectal Surgery: A Collaborative Program for Improving Surgical Care and Recovery

<h3>Background</h3> Surgical site infection (SSI) following colorectal surgery is a common infectious complication and is associated with high mortality and increased medical costs. The Infection Preventionists (IPs) identified a high colorectal surgery (COLO) SSI incidence during surveillance. The purpose of this study is to demonstrate the effectiveness of COLO SSI reduction by initiating an evidence-based Improving Surgical Care and Recovery (ISCR) program. <h3>Methods</h3> This ISCR program was launched in March 2018. Pre-intervention was from January 2017 to February 2018. Post-intervention was from March 2018 to October 2019. Post-intervention data was compared with pre-intervention data to gauge effectiveness. A manufacturer's stapler recall was announced in April 2019. Malfunctioning staplers were used in surgeries from October to April 2019 (impact period). Electronic medical records were reviewed. Cases were identified using National Healthcare Safety Network (NHSN) SSI definitions. COLO SSI standardized infection ratios (SIR) were obtained from NHSN "Adult all SSI by procedure" data. Direct observation was performed by IPs. Potential deficiencies were identified using a self-administered staff survey. Recommendations were made to limit personnel traffic, improve surgical hand scrub, use chlorhexidine gluconate (CHG) for pre-surgery skin decolonization, manage glucose perioperatively/intraoperatively/postoperatively, maintain perioperative normothermia, deliver proper antimicrobial prophylaxis, and use CHG for skin preparation. Oral antibiotics and mechanical bowel preparation for elective colorectal surgery were implemented. <h3>Results</h3> Pre-intervention SIR was 2.50 including 28% superficial infections (SIP), 20% deep incision infections (DIP), and 52% intra-abdominal infections (IAB). Post-intervention SIR was 0.86 including 17% SIP, 17% DIP, and 67% IAB. Three IAB SSI cases had surgeries during the impact period. (Post-intervention vs. pre-intervention: relative ratio "RR"=0.34, 95% CI 0.106-0.995. p-value=0.04). <h3>Conclusions</h3> Effectiveness of the COLO SSI prevention bundle is significant. A multidisciplinary approach to implement, evaluate and improve compliance with ISCR recommendations reduced COLO SSI SIR by 66%.