Ann Surg Treat Res.  2020 Nov;99(5):285-293. 10.4174/astr.2020.99.5.285.

Implementing a multidisciplinary care bundle to reduce colon surgical site infections

• Park CM
• Ha TS
• Lee WY
• Chung DR
• Park YA
• Choi JR
• Jeong NY

• KMID: 2508325
• DOI: http://doi.org/10.4174/astr.2020.99.5.285

Abstract

Purpose
The aim of this study was to investigate how rates of surgical site infections (SSI) were changed over 2 years after applying colon SSI bundle in patients who underwent colon surgery.
Methods
The multidisciplinary working group developed a care bundle consisting of 8 components, including several recommendations of Surgical Care Improvement Project and monitoring of medical/surgical hand washing. We implemented the care bundle for each patient who underwent colon surgery from April 2013 to December 2014.
Results
Overall bundle compliance was 87.9% before implementation, 88.2% in 2013, and 90.5% in 2014. In particular, compliance of the following 3 components was substantial improved during the project period; discontinuation of prophylactic antimicrobial agent within 24 hours of surgery (from 88.3% to 100%), surgical hand washing (from 50.0% to 78.9%), and medical hand washing (from 74.7% to 82.8%). The rate of SSI was 8.0% (12/150) during 3 months before implementation, 3.3% (16/480) from April to December in 2013, and 2.3% (14/607) in 2014.
Conclusion
After implementation of multidisciplinary care bundle, the compliance of each component was increased and rates of SSIs were significantly decreased compared to those before the quality improvement project.

Keyword

Bundle; Colorectal surgery; Compliance; Surgical wound infection

Figure

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  Fig. 1 Patients' flow chart. ICU, intensive care unit.

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  Fig. 2 Compliances of colon surgical site infection bundle (8 elements). (A) Prophylactic antibiotics within 1 hour, prophylactic antibiotics selection, prophylactic antibiotics discontinued within 24 hours, and appropriate hair removal. (B) Perioperative temperature management, Foley catheter removal within postoperative 2 days, medical hand washing, and surgical hand washing.

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  Fig. 3 The quarterly rates of surgical site infections (SSI). Preintervention and postintervention: from 1st to 7th quarter.

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  Fig. 4 Comparison of yearly surgical site infections.

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