Challenges Related to Surgical Site Infection Prevention-Results after Standardized Bundle Implementation.

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Version: author
License: CC BY 4.0
Serval ID
serval:BIB_15B074390F67
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Challenges Related to Surgical Site Infection Prevention-Results after Standardized Bundle Implementation.
Journal
Journal of clinical medicine
Author(s)
Jurt J., Hübner M., Clerc D., Curchod P., Abd El Aziz M.A., Hahnloser D., Senn L., Demartines N., Grass F.
ISSN
2077-0383 (Print)
ISSN-L
2077-0383
Publication state
Published
Issued date
29/09/2021
Peer-reviewed
Oui
Volume
10
Number
19
Pages
4524
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The aim of this study was to assess the implementation of an intraoperative standardized surgical site infection (SSI) prevention bundle.
The multimodal, evidence-based care bundle included nine intraoperative items (antibiotic type, timing, and re-dosing; disinfection; induction temperature control > 36.5°; glove change; intra-cavity lavage; wound protection; and closure strategy). The bundle was applied to all consecutive patients undergoing colonic resections. The primary outcome, SSI, was independently assessed by the National Infection Surveillance Committee for up to 30 postoperative days. A historical, institutional pre-implementation control group (2012-2017) with an identical methodology was used for comparison.
In total, 1516 patients were included, of which 1256 (82.8%) were in the control group and 260 (17.2%) were in the post-implementation group. After 2:1 propensity score matching, the groups were similar for all items (p > 0.05). Overall compliance with the care bundle was 77% (IQR 77-88). The lowest compliance rates were observed for temperature control (53% overall), intra-cavity lavage (64% overall), and wound protection and closure (68% and 63% in the SSI group, respectively). Surgical site infections were reported in 58 patients (22.2%) vs. 21.4% in the control group (p = 0.79). Infection rates were comparable throughout the Centers for Disease Control and Prevention (CDC) categories: superficial, 12 patients (4.5%) vs. 4.2%, p = 0.82; deep incisional, 10 patients (3.7%) vs. 5.1%, p = 0.34; organ space, 36 (14%) vs. 12.4%, p = 0.48. After propensity score matching, rates remained comparable throughout all comparisons (all p > 0.05).
The implementation of an intraoperative standardized care bundle had no impact on SSI rates. This may be explained by insufficient compliance with the individual measures.
Keywords
General Medicine, bundle, colorectal, compliance, surgical site infection
Pubmed
Web of science
Open Access
Yes
Create date
06/10/2021 11:01
Last modification date
06/11/2021 7:37
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