Simple Operating Room Bundle Reduces Superficial Surgical Site Infections After Major Urologic Surgery

To reduce our superficial surgical site infection rate following major urologic surgery by implementing a simple operating room bundle.

A simple operating room bundle was applied to all major urologic cases (cystectomy, nephrectomy, and prostatectomy) at a single tertiary referral center. The bundle included allowing skin prep to dry appropriately, changing gloves before skin closure, irrigating the wound before skin closure, and using a new separate sterile closing instrument set for skin closure. Alcohol-based preps were also introduced hospital-wide 3 months into the study period. The SSI rate was obtained from the National Surgical Quality Improvement Program (NSQIP) database.

The surgical site infection (SSI) rate was assessed after a 14-month study period for a total of 510 cases. Before instituting the alcohol-based prep, but after the bundle was implemented, 138 cases were analyzed over a 3-month period with an SSI rate of 0%. For the remaining 11 months with both the alcohol-based prep and the infection prevention bundle in place, the infection rate was 1.37% (7/510) as compared with 3.57% (22/615) for the 12-month period before bundle introduction, a statistically significant reduction (P = .023).

The SSI rate after major urologic surgery at 1 center was reduced after the introduction of a simple, fast, low-cost, and easily reproducible bundle into the operating room. The use of this bundle reduces SSI, which is critical for the patient and the physician in this era of public reporting and reimbursement based on outcomes.