Evaluation of a bundle of care to reduce incisional surgical site infection after gastrointestinal surgery.

Phelan, Liam, Dilworth, Mark P, Bhangu, Aneel, Limbrick, Jack W, King, Stratton, Bowley, Doug M and Hardy, Katie (2020) Evaluation of a bundle of care to reduce incisional surgical site infection after gastrointestinal surgery. Journal of infection prevention, 21 (2). pp. 52-59. ISSN 1757-1774. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: http://www.uk.sagepub.com/journals/Journal201867

Abstract

Background

Surgical site infection (SSI) is associated with morbidity, mortality and increased care costs; many SSIs are considered preventable. The aim of the present study was to test implementation of a pragmatic, evidence-based bundle designed to reduce incisional SSI after emergency laparotomy and elective major lower gastrointestinal surgery.

Method

This was a prospective before-and-after study. Data were collected before the intervention and for two separate subsequent time periods. An evidence-based bundle of care (BOC) was implemented; the primary outcome measure was incisional SSI at 30 days. The secondary outcome measure was 30-day unplanned readmissions. The initial post-intervention group, Group 2, assessed a variable number of potential impacting factors; however, due to funding and staffing levels the second post-bundle group, Group 3, focused on the core aspects of the BOC and rates of incisional SSI and readmission.

Results

In total, 99 patients were included in the 'before' group; and 71 in Group 2 and 92 in Group 3, the post-intervention groups. The incisional SSI rate was 29.3% (29/99) before and 28.2% (20/71) in Group 2 (=0.873) and 21.7% (20/92) in Group 3 (=0.234) after the intervention. After adjustment for confounders, the care bundle was associated with a non-significant reduction in SSI (Group 2: odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.45-1.93, =0.0843). However, it was associated with significantly reduced readmissions 18.1% (18/99) before versus 5.6% (4/71) in Group 2 (OR = 0.236, 95% CI = 0.077-0.72, =0.012) and 8.7% (8/92) in Group 3 (OR = 0.38, 95% CI = 0.16-0.9, =0.029). Comparing the pre-bundle group to the post-bundle groups, there was an overall significant reduction in readmissions (=0.003). This implies a number needed to treat of 8-11 patients to prevent one readmission. Adherence to antibiotic prophylaxis with the Trust guidelines increased from 91% to 99% (1 vs. 2, =0.047).

Conclusion

Introduction of the bundle was associated with a reduction in the observed rate of incisional SSI from 29.3% to 21.7%; significantly fewer patients required unplanned readmission. Use of the bundle was associated with significantly improved compliance with appropriate antimicrobial prophylaxis.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WO Surgery
Divisions: Planned IP Care > General Surgery
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 20 Jan 2021 14:28
Last Modified: 20 Jan 2021 14:28
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3871

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