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. 2012 Summer;16(3):10-6.
doi: 10.7812/TPP/12.968.

A colorectal "care bundle" to reduce surgical site infections in colorectal surgeries: a single-center experience

Waleed Lutfiyya  1 , David Parsons, Juliann Breen
Affiliations

A colorectal "care bundle" to reduce surgical site infections in colorectal surgeries: a single-center experience

Waleed Lutfiyya et al. Perm J. 2012 Summer.

Abstract

Background: Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) since January 2006. Data on general and colorectal surgical site infections (SSIs) demonstrated a need for improvement in SSI rates.

Objective: To evaluate application of a "care bundle" for patients undergoing colorectal operations, with the goal of reducing overall SSI rates.

Methods: We prospectively implemented multiple interventions, with retrospective analysis of data using the NSQIP database. The overall, superficial, deep, and organ/space SSI rates were compared before and after implementation of this colorectal care bundle.

Results: Between January 2006 and December 2009, there were 430 colorectal cases in our NSQIP report with 91 infections, an overall rate of 21.16%. Between January 2010, when the colorectal care bundle was implemented, and June 2011, there were 195 cases and 13 infections, a 6.67% overall rate. The absolute decrease of 14.49% is significant (p < 0.0001). The rate of superficial SSI decreased from 15.12% to 3.59% (p < 0.0001). The rates for deep and organ/space SSI also showed a decrease; however, this was not statistically significant. The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation (fiscal year 2010).

Conclusions: Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases. By instituting a care bundle composed of core and adjunct strategies, we significantly decreased our rate of colorectal SSIs.

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Figures

Figure 1
Figure 1
P Chart for Colorectal Surgery SSI Rates at KSMC, January 2006 to July 2011. CL = control limit (grey straight line at bottom); KSMC = Kaiser Sunnyside Medical Center; SSI = surgical site infection; UCL = upper control limit (thin lines at top).
Figure 2
Figure 2
Rates of Colorectal SSI Between KSMC and NSQIP. KSMC = Kaiser Sunnyside Medical Center; NSQIP = National Surgical Quality Improvement Program; SSI = surgical site infection.
See this image and copyright information in PMC

References

    1. Tang R, Chen HH, Wang YL, et al. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2809 consecutive patients. Ann Surg. 2001 Aug;234(2):181–9. - PMC - PubMed
    1. Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006 Dec 21;355(25):2640–51. - PubMed
    1. Wick EC, Shore AD, Hirose K, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011 Dec;54(12):1475–9. - PubMed
    1. Khuri SF. The NSQIP: a new frontier in surgery. Surgery. 2005 Nov;138(5):837–43. - PubMed
    1. Rowell KS, Turrentine FE, Hutter MM, Khuri SF, Henderson WG. Use of National Surgical Quality Improvement Program data as a catalyst for quality improvement. J Am Coll Surg. 2007 Jun;204(6):1293–300. - PubMed

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