F. Gaunay1, T. Adegboyega1, C. Sanz1, M. Berrones1, D. Rivadeneira1 1North Shore University And Long Island Jewish Medical Center,Colon & Rectal Surgery,Manhasset, NY, USA
Introduction:
Surgical site infections (SSIs) represent significant morbidity and financial implications following colon surgery. The objective of this prospective study is to compare clinical outcomes pre- and post- implementation of a dedicated colon surgery bundle to reduce SSIs in our health system.
Methods:
A prospective study was conducted in which a dedicated colon surgery bundle and interdisciplinary team for its implementation was established. The twenty-five components of the colon surgery bundle were divided into pre-hospital, pre, intra, and post-operative measures. These included standardized pre-operative mechanical bowel preparation and oral antibiotics and body wash skin cleansing, alcohol-based skin preparation, intra- and peri-operative maintenance of normothermia, therapeutic levels of antimicrobial prophylaxis and optimal tissue oxygenation, glucose control, and the introduction of a clean standardized fascial closure process, and negative pressure wound therapy. Specific enhanced pre-operative patient education was also provided. Consecutive patients who underwent a colorectal procedure between January 2015 and January 2016. SSIs were recorded and subdivided by surgical wound class.
Results:
SSIs were identified in 11/198 patients (7%) eligible for colon bundle implementation. When compared to the year prior to implementation of the colon bundle, SSIs where identified in 26/175 (15%). Implementation of the colon bundle led to a significant decrease in SSIs 7% vs. 15%, (p <0.05). Additionally, SSIs observed in clean-contaminated and contaminated procedures decreased from 34.6% to 14.3% and 38.5% to 14.3%, respectively (p<0.05%).
Conclusion:
We demonstrate in this prospective study that the implementation of a specific colon bundle resulted in a 54% decrease in post-operative SSIs. The greatest reduction of SSIs was seen in wound classes II and III. We also show a very high adoption and compliance of the colon bundle with a dedicated implementation of an interdisciplinary team. This approach to incorporating an advanced surgery bundle for colon and rectal procedures can provide an effective strategy to reduce SSIs.