Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections
Author:
Weiser M R1ORCID, Gonen M2, Usiak S3, Pottinger T4, Samedy P4, Patel D4, Seo S5, Smith J J1, Guillem J G1, Temple L1, Nash G M1, Paty P B1, Baldwin-Medsker A6, Cheavers C E4, Eagan J3, Garcia-Aguilar J1, Afonso A7, Aslam A7, Baldwin-Medsker A7, Burns J7, Canny M7, Cheavers C E7, Cohen N7, Eagan J7, Evans N7, Ferrari C7, Fiordaliso C7, Fitzpatrick C7, Freeman R7, Garcia-Aguilar J7, Gilbert M7, Gonen M7, Guillem J G7, Hailemariam M7, Hammel J7, Healy K7, Hoskins W7, Isaac L7, Kim W7, Kitzler R7, Levine K7, Marcelli A7, Marx W7, Matthews L7, Monether C7, Nash G M7, Nolan S7, Ottey H7, Patel D7, Patterson P7, Paty P B7, Pottinger T7, Prather A7, Riffle M7, Rodrigue D7, Romanoff S7, Russo T7, Samedy P7, Seo S K7, Sepkowitz K7, Smith J J7, Sokoli D7, Swift L7, Temple L7, Usiak S7, Vassallo C7, Vincenzino A7, Wall L7, Walters C7, Weiser M R7, Yeung K7
Affiliation:
1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA 3. Infection Control Program, Memorial Sloan Kettering Cancer Center, New York, USA 4. Division of Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, USA 5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA 6. Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, USA 7. Memorial Sloan Kettering Cancer Center, New York, USA
Abstract
Abstract
Background
Surgical-site infection (SSI) is associated with significant healthcare costs. To reduce the high rate of SSI among patients undergoing colorectal surgery at a cancer centre, a comprehensive care bundle was implemented and its efficacy tested.
Methods
A pragmatic study involving three phases (baseline, implementation and sustainability) was conducted on patients treated consecutively between 2013 and 2016. The intervention included 13 components related to: bowel preparation; oral and intravenous antibiotic selection and administration; skin preparation, disinfection and hygiene; maintenance of normothermia during surgery; and use of clean instruments for closure. SSI risk was evaluated by means of a preoperative calculator, and effectiveness was assessed using interrupted time-series regression.
Results
In a population with a mean BMI of 30 kg/m2, diabetes mellitus in 17·5 per cent, and smoking history in 49·3 per cent, SSI rates declined from 11·0 to 4·1 per cent following implementation of the intervention bundle (P = 0·001). The greatest reductions in SSI rates occurred in patients at intermediate or high risk of SSI: from 10·3 to 4·7 per cent (P = 0·006) and from 19 to 2 per cent (P < 0·001) respectively. Wound care modifications were very different in the implementation phase (43·2 versus 24·9 per cent baseline), including use of an overlying surface vacuum dressing (17·2 from 1·4 per cent baseline) or leaving wounds partially open (13·2 from 6·7 per cent baseline). As a result, the biggest difference was in wound-related rather than organ-space SSI. The median length of hospital stay decreased from 7 (i.q.r. 5–10) to 6 (5–9) days (P = 0·002). The greatest reduction in hospital stay was seen in patients at high risk of SSI: from 8 to 6 days (P < 0·001). SSI rates remained low (4·5 per cent) in the sustainability phase.
Conclusion
Meaningful reductions in SSI can be achieved by implementing a multidisciplinary care bundle at a hospital-wide level.
Funder
National Cancer Institute
Publisher
Oxford University Press (OUP)
Cited by
61 articles.
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