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Reducing surgical site infections in patients undergoing pancreatic resection: a quality improvement initiative
Richard W Gilbert1,2, Michelle Kwon2, Muhammad Uzair Khalid3
1Department of Surgery, Ottawa General Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Background:
Surgical site infections (SSIs) represent a significant source of morbidity during pancreaticoduodenectomy. The use of piperacillin-tazobactam (pip-tazo) has been shown to significantly reduce the incidence of SSI in this patient population. We thus elected to perform a quality improvement (QI) project to reduce superficial and deep SSI rates by ensuring all patients received pip-tazo as antibiotic prophylaxis.
Methods:
We collected baseline retrospective data on a historical cohort of patients undergoing pancreaticoduodenectomy or total pancreatectomy from 1 January 2022 to 31 December 2022. We then launched our QI project on 1 January 2023, consisting of a multidisciplinary team creation and numerous outreach activities. The project had two Plan, Do, Study, Act (PDSA) cycles and ran until April 2024. The Standards for Quality Improvement Reporting Excellence guidelines were used to report results.
Results:
Baseline cohort data included 64 patients, with 32% receiving pip-tazo and 39% developing an SSI. During phase one of our QI project (1 January 2023-31 August 2023), 54 patients underwent surgery, 90.7% received pip-tazo and 27.8% developed an SSI. Those who had undergone preoperative biliary stenting had a higher SSI rate (46.9% vs 4.4%). We thus added a second SSI reduction measure to patients with biliary stents: the ringed wound protector. During the second phase of our QI project (1 September 2023-1 April 2024), 51 patients underwent surgery, 98.0% received pip-tazo and 65.0% had a wound protector placed. SSI rates in this group were 9.8%.
Conclusion:
We describe a QI project whereby we increased the rates of correct antibiotic dosing in patients undergoing pancreatectomy to 98.0%. Although pip-tazo reduced SSI rates, the addition of a ringed wound protector in patients at high risk further reduced rates of SSI. We thus suggest the use of pip-tazo and ringed wound protectors as an effective strategy to reduce SSI rates in patients undergoing pancreatectomy.
Insights
Implementing piperacillin-tazobactam (pip-tazo) prophylaxis and wound protectors significantly reduced surgical site infections (SSIs) in pancreaticoduodenectomy patients. This quality improvement project achieved high compliance with pip-tazo and demonstrated the benefit of wound protectors for high-risk patients.
Area of Science:
- Surgical Oncology
- Infectious Disease Prevention
- Quality Improvement in Healthcare
Background:
- Surgical site infections (SSIs) are a major complication following pancreaticoduodenectomy.
- Piperacillin-tazobactam (pip-tazo) prophylaxis has shown promise in reducing SSI rates in this patient population.
- A quality improvement (QI) initiative was designed to enhance SSI prevention strategies.
Purpose of the Study:
- To decrease superficial and deep SSI rates in patients undergoing pancreatectomy.
- To improve the adherence to appropriate antibiotic prophylaxis protocols.
- To evaluate the impact of additional measures for high-risk patient subgroups.
Main Methods:
- A retrospective baseline data collection was performed for patients from January 2022 to December 2022.
- A QI project was implemented from January 2023 to April 2024, involving a multidisciplinary team and PDSA cycles.
- Data were analyzed according to the Standards for Quality Improvement Reporting Excellence (SQuIRE) guidelines.
Main Results:
- Baseline: 64 patients, 32% received pip-tazo, 39% developed SSI.
- Phase 1 (9 months): 54 patients, 90.7% received pip-tazo, 27.8% developed SSI; higher SSI rates observed in patients with preoperative biliary stenting (46.9%).
- Phase 2 (7 months): 51 patients, 98.0% received pip-tazo, 9.8% developed SSI after implementing ringed wound protectors for high-risk patients.
Conclusions:
- The QI project successfully increased the administration rate of appropriate antibiotic prophylaxis (pip-tazo) to 98.0%.
- While pip-tazo reduced SSI rates, the addition of ringed wound protectors further decreased SSI incidence in high-risk patients.
- Combining pip-tazo with ringed wound protectors is a recommended strategy to minimize SSIs in pancreatectomy patients.
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