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Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial.

Thomas Anthony¹, Bryce W Murray, John T Sum-Ping

¹Department of Surgical Services, Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX 75216, USA. thomas.anthony@va.gov

Archives of Surgery (Chicago, Ill. : 1960)

|November 17, 2010

Summary

This summary is machine-generated.

An evidence-based practice bundle did not reduce surgical site infections (SSIs) in colorectal surgery patients. The bundled interventions unexpectedly increased SSI rates compared to standard care, highlighting the need for formal testing of combined approaches.

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Published on: August 19, 2025

Area of Science:

Surgical infection prevention
Evidence-based medicine
Clinical trial methodology

Background:

Surgical site infections (SSIs) are a significant complication following colorectal surgery.
Evidence-based practices (EBPs) are often bundled to improve patient outcomes.
The efficacy of bundled EBPs for reducing SSIs requires rigorous evaluation.

Purpose of the Study:

To evaluate the effectiveness of an evidence-based practice bundle in reducing the rate of surgical site infections (SSIs) after elective transabdominal colorectal surgery.
To compare the SSI rate in patients receiving a bundle of five EBPs versus standard surgical care.

Main Methods:

A single-institution, randomized controlled trial was conducted with blinded outcome assessment.
Eligible patients undergoing elective transabdominal colorectal surgery were randomized into two groups: an extended arm receiving the EBP bundle and a standard arm receiving current practice.
The EBP bundle included omission of mechanical bowel preparation, preoperative and intraoperative warming, supplemental oxygen, fluid restriction, and a surgical wound protector.

Main Results:

The overall SSI rate was significantly higher in the extended arm (45%) compared to the standard arm (24%) (P = .003).
Superficial incisional SSIs were the most common type of infection, also higher in the extended arm (36% vs 19%, P = .004).
Multivariate analysis indicated that the extended arm independently conferred a 2.49-fold increased risk of SSI.

Conclusions:

The tested evidence-based practice bundle did not reduce SSIs and, in fact, increased the infection rate.
Bundling interventions, even those individually proven effective, does not guarantee a predictable positive outcome.
Formal testing of bundled interventions is crucial before widespread clinical implementation to avoid unintended consequences.