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. 2012;7(9):e44599.
doi: 10.1371/journal.pone.0044599. Epub 2012 Sep 4.

Reduction of surgical site infections after implementation of a bundle of care

Rogier M P H Crolla  1 , Lijckle van der Laan, Eelco J Veen, Yvonne Hendriks, Caroline van Schendel, Jan Kluytmans
Affiliations

Reduction of surgical site infections after implementation of a bundle of care

Rogier M P H Crolla et al. PLoS One. 2012.

Abstract

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Compliance with the bundle and its individual components in repeated measurements from June 2009 through October 2011.
Figure 2
Figure 2. Annual changes in the surgical site infection (SSI) rate and bundle compliance and the 95% confidence interval.
Footnote: 2008 was taken as the reference year for SSI and the relative changes after adjustment for confounding variables are provided.
Figure 3
Figure 3. Kaplan meier curve of 6 months mortality in patients with and without a surgical site infection (SSI).
See this image and copyright information in PMC

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