Sustained reduction in surgical site infection after abdominal hysterectomy

During a period of five years, the rate of surgical site infection (SSI) after abdominal hysterectomy at our institution was >10%. With the implementation of a multifaceted intervention designed to reduce this, the rate of SSI fell to <2% in the post-intervention period. The pre- and post-intervention periods were compared to determine which of the interventions in the multifaceted array of interventions was most valuable in decreasing SSI.

A retrospective chart review was done to identify: (1) Parameters associated with SSI, and (2) parameters that differed in the pre- and post-intervention periods. The intervention included providing departmental SSI rates to the gynecology faculty, re-educating operating room (OR) staff personnel about appropriate perioperative antibiotic choice and timing, and changing the preferred sterile preparation for abdominal surgery from 10% povidone-iodine (PI) to 4% chlorhexidine gluconate (CHG). The preliminary results of our review also led to the suggestion that surgeons use blood products sparingly, although an absolute threshold for transfusion was not specified.

Twenty-one of 192 patients (10.7%) developed an SSI in the pre-intervention period, whereas 1 of 84 patients (1.2%) developed an SSI in the post-intervention period (p=0.006). Surgical site infection was associated with obesity (a body mass index [BMI] ≥30) (11.5% vs. 4.8%, p=0.04), receipt of a blood transfusion (18.2% vs. 6.6%, p=0.03), and abdominal skin preparation with PI as opposed to CHG (10.1% vs. 2.0%, p=0.07). Chlorhexidine gluconate was used more commonly for abdominal skin preparation in the post- than in the pre-intervention period (6.6% pre-intervention vs. 50.7% post-intervention, p <0.0001).

A multifaceted intervention decreased dramatically the rate of SSI after abdominal hysterectomy at our institution. No single component of the intervention could be identified as most responsible for the improvement.