Prospective “Surgical Site Infection Prevention Bundle Project” in a High Outlier Institution
Author(s):
Emre Gorgun, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic; Ahmet Rencuzogullari, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic; Volkan Ozben, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic; Luca Stocchi, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic; Thomas Fraser, Departments of Infectious Diseases, Quality and Patient Safety Institute, Cleveland Clinic; Feza Remzi, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic
Background: Surgical site infections (SSI) are the most common hospital-acquired infection after colorectal surgery, and increase morbidity, mortality and hospital costs. The aim of this study was to investigate the impact of preventive measures on colorectal SSI rates in a high volume institution with inherent high-risk procedures.
Hypothesis: Considerabl reduction in surgical site ifection rates can be achived by implementing prevetive measures with a high compliance rate.
Methods: The ''SSI Prevention Bundle Project'' was implemented in our colorectal surgery department in February 2014. This bundle includes 14 pre-, intra- and postoperative measures aimed to reduce colorectal SSI occurrence (Figure). A SSI data collection sheet was developed and used to track progress. One-year outcomes were compared with those from a pre-bundle period.
Results: From February 2013 to February 2015, 2279 abdominal colorectal surgical procedures were performed; 986 (43.3%) during the pre-bundle period (February 2013 to February 2014) and 1292 (56.7%) after the bundle project was started (February 2014 to February 2015). Patient characteristics and comorbidities were similar in both periods. Compliance to preventive measures ranged between 75 % and 99 % during the bundle period. The overall SSI rate decreased from 11.8% at pre-bundle to 6.5% at bundle period (p<0.001). Although decrease for all types of SSIs was observed after the bundle implementation, a significant reduction was only achieved in organ-space SSI subgroup (5.5% to 1.8%; p<0.001). The logistic regression models for overall SSI.are given in Table.
Conclusions: The prospective SSI Prevention Bundle Project resulted in a substantial decline in SSI rates in our colorectal surgery department. Collaborative and enduring efforts among multiple providers are critical to achieve a sustained SSI reduction