Surgical site infection prevention care bundles in colorectal surgery: a scoping review

Abstract

Background: Surgical site infection (SSI) prevention bundles have been used to reduce infection rates in most types of surgery. Bundles tailored to colorectal surgery have been used with success.

Aim: To identify and review the individual interventions that constitute each SSI prevention care bundle in colorectal surgery, and the reduction in SSI rate associated with their implementation.

Methods: A scoping review was conducted in PubMed, CINAHL, Web of Science Core Collection and Scopus in December 2022.

Results: This review analysed 48 of 164 identified studies on SSI prevention in colorectal surgery from 2011 to 2022. It revealed an average of 11 interventions per study, primarily in the pre-operative [mechanical bowel preparation, oral antibiotic bowel decontamination, hair removal, chlorhexidine gluconate (CHG) shower, normoglycaemia], intra-operative (antibiotic prophylaxis, normothermia, CHG skin preparation, antibiotic prophylaxis re-dosing, gown/glove change) and postoperative (normothermia, normoglycaemia, dressing removal, oxygen optimization, incision cleansing) periods. Despite these interventions, SSI rates remain high, indicating a need for further research to optimize intervention bundles and improve compliance across surgical stages.

Conclusions: The implementation of SSI prevention bundles, tailored to colorectal surgery, has shown a reduction in SSI rates and costs. Grouping interventions according to the peri-operative phase may increase compliance.

Keywords: Colorectal surgery; Patient care bundles; Scoping review; Surgical site infections.