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

Area of Science:

• Surgery
• Infectious Diseases
• Healthcare Quality Improvement

Background:

• Surgical site infections (SSIs) are a significant concern following colonic resections.
• Standardized care bundles are evidence-based strategies to reduce SSIs.
• Assessing the real-world implementation and impact of such bundles is crucial.

Purpose of the Study:

• To evaluate the effectiveness of an intraoperative, standardized care bundle in preventing SSIs after colonic surgery.
• To determine the compliance rates with individual components of the implemented bundle.
• To compare SSI rates before and after the implementation of the bundle.

Main Methods:

• A multimodal, evidence-based care bundle comprising nine intraoperative measures was implemented for colonic resections.
• A historical control group (2012-2017) was used for comparison.
• Surgical site infections were assessed up to 30 days postoperatively by an independent committee. Propensity score matching was used to control for confounding variables.

Main Results:

• Overall compliance with the care bundle was 77%, with notable variations in adherence to specific components like temperature control (53%) and wound protection (63%).
• No significant difference in overall SSI rates was observed between the post-implementation group (22.2%) and the control group (21.4%, p=0.79).
• Infection rates remained comparable across all Centers for Disease Control and Prevention (CDC) categories (superficial, deep incisional, organ space) after propensity score matching.

Conclusions:

• The implementation of the intraoperative standardized care bundle did not lead to a reduction in surgical site infection rates.
• Suboptimal compliance with individual bundle components is a likely reason for the lack of observed effect.
• Further strategies to improve adherence to evidence-based practices are necessary to impact SSI rates effectively.