Document Detail

Reduction of surgical site infections after implementation of a bundle of care.
MedLine Citation:
PMID:  22962619     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Surgical Site Infections (SSI) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality.
OBJECTIVE: Implementing a bundle of care and measuring the effects on the SSI rate.
DESIGN: Prospective quasi experimental cohort study.
METHODS: A prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures.
RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5%) occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days) and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76-4.18). Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008.
CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety.
Rogier M P H Crolla; Lijckle van der Laan; Eelco J Veen; Yvonne Hendriks; Caroline van Schendel; Jan Kluytmans
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Publication Detail:
Type:  Journal Article     Date:  2012-09-04
Journal Detail:
Title:  PloS one     Volume:  7     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2012  
Date Detail:
Created Date:  2012-09-10     Completed Date:  2013-01-22     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e44599     Citation Subset:  IM    
Department of surgery, Amphia Hospital, Breda, The Netherlands.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Antibiotic Prophylaxis*
Colon / surgery*
Digestive System Surgical Procedures / adverse effects*
Length of Stay
Logistic Models
Middle Aged
Patient Safety
Perioperative Care / methods*,  standards
Prospective Studies
Rectum / surgery*
Surgical Wound Infection / drug therapy,  mortality,  prevention & control*
Survival Rate
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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