A bundle of care to reduce colorectal surgical infections: an Australian experience

Bull, Ann; Wilson, Jill; Worth, Leon J; Stuart, Rhonda L.; Gillespie, Elizabeth; Waxman, Bruce P.; Shearer, William; Richards, Michael J.

doi:10.1016/j.jhin.2011.03.029

Cited by 74 publications

(67 citation statements)

References 14 publications

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“…The inability to achieve high compliance is commonly cited as a reason why quality improvement programs fail. 6,18,37,38 To avoid this potential pitfall, elements of the ERP and SSIB have been protocolized and integrated into physician order sets, which has facilitated reliable delivery of these programs. Additionally, CRS leadership meets frequently with members of the multidisciplinary team that enacts the components of these programs in order to reinforce program objectives, identify problem areas, and improve program coordination.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17] Similarly, the SSIB is a perioperative care program that systematically provides evidence-supported measures for surgical wound infection prevention and has been shown to reduce the rate of postoperative wound infection. [18][19][20][21][22] Although both the ERP and SSIB have individually been shown to improve outcomes after CRS, the effect of their combined presence has not, to our knowledge, previously been reported in the literature. The colorectal surgery service at our institution sequentially implemented the ERP in February 2010, followed by the SSIB in July 2011; together they have profoundly altered the practice of CRS at our institution.…”

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confidence: 99%

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Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

Keenan

Speicher

Nussbaum

et al. 2015

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

Keenan

Speicher

Nussbaum

et al. 2015

Journal of the American College of Surgeons

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“…1,7 The use of preventive bundles, defined as "a set of interventions that, when performed together, promote best outcomes with a greater impact than if performed individually" 9 has gained popularity as a way to address high SSI rates. Despite some deviations in components, bundles applied to all patients might have limited success 4,10,11,12,13 and may not be costeffective. Recently released reports with increased SSI rates even after implementation of the intervention bundle 4,11 rendered the routine implementation of bundles to all patients controversial.…”

Section: Introductionmentioning

confidence: 99%

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Rencüzoğulları¹,

Trunzo²,

Vogel³

et al. 2018

TJCD

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Aim: Applying prevention bundles to all patients to reduce surgical site infections (SSI) after colorectal surgery is expensive and has minimal success. The aim of this study was to identify factors associated with high-risk of superficial SSI and to assess the impact of prevention measures on high-risk patients. Method: Between January 2010 and February 2014, patients who underwent colorectal surgical procedures were separated into the pre-bundle period (January 2010-July 2012) and bundle period (August 2012-February 2014. Factors associated with superficial SSI risk were evaluated. Pre-bundle and bundle patients were categorized in deciles from low-to high-risk using a risk model. The impact of prospectively introduced protective measures was assessed in the bundle patients with multivariate modeling and frequency-matched analysis. Results: There were 2.535 pre-bundle patients who underwent ileocolic (19.1%), left-sided (46%), and pelvic (34.9%) procedures. Overall superficial SSI rate was 10.7%. Four patient-related factors and five procedure-related factors were found to be significantly associated with superficial SSI on unadjusted analysis. Comparison of pre-bundle patients on whom the risk model was built and the bundle patients used in the risk assessment showed significant decrease in superficial SSI rates (10.6% to 3.2%, p<0.001). Frequency matched analysis demonstrated a significant reduction in superficial SSI from pre-bundle to bundle patients (13.1 to 4.2%, p<0.001). Among the risk deciles in bundle patients, the reduction from the average predicted risk to the observed superficial SSI rate was most evident among the high-risk groups. Conclusion: Preventive strategies specifically aimed at patients with the highest risk for superficial SSI after colorectal surgery resulted in the highest reduction. Considering the variability of SSI rates, collaborative and targeted policies are critical to ensure efficacious and potentially cost-effective strategies. Keywords: Superficial surgical site infection, prevention bundle, colorectal surgery, high-risk patients Amaç: Kolorektal cerrahi sonrası cerrahi alan enfeksiyonlarını (CAE) azaltmak için hazırlanan önlem paketlerinin tüm hastalara uygulanması pahalı olup minimal başarıya sahiptir. Bu çalışmada yüksek riskli yüzeyel CAE'leri ile ilişkili faktörler ve koruyucu önlemlerin yüksek riskli hastalardaki etkinliğini değerlendirmek amaçlanmıştır. Yöntem: 2010 Ocak ve 2014 Şubat tarihleri arasında kolorektal eksizyon uygunlanan hastalar önlem demeti öncesi (2010 Ocak-2012 Ağustos) ve demet dönemi (2012 Ağustos-2014 Şubat) olmak üzere identifiye edildi. Yüzeyel CAE riski ile ilişkili faktörler değerlendirildi. Demet öncesi ve demet dönemi periyoduna ait hastalar risk modeli oluşturularak 1/10'luk gruplar şeklinde düşük riskten yüksek riske doğru kategorize edildi. Demet dönemi periyoduna ait hastalara prospektif olarak uygulanan koruyucu önlemlerin etkisi çok değişkenli modelleme ve frekans-eşlemeli analiz ile değerlendirildi. Bulgular: İleokolik (%19,1)...

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“…4,5,6 Yüzeyel ya da derin cerrahi alan enfeksiyonları farklı patogenez ve risk faktörleri ile ortaya çıkarlar ve direkt olarak cerrahi prosedürler ilişkilidir. 2,7 Her cerrahi prosedürde gerçekleştirilen teknik farklı bir inflamatuar cevap yaratır.…”

Section: Introductionunclassified

Predictive Factors for the Development of Surgical Site Infection After Colorectal Cancer Surgery

Aydın¹,

Soylu²

2018

TJCD

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Aim: In this study, we wanted to reveal the predisposing factors and cut-off values for surgical site infection in patients who were operated for colorectal cancer. Method: We retrospectively analyzed data of 86 patients who were operated for colorectal cancer in our general surgery department in between 2015-2017. Age, gender, body mass index, ASA score, presence of chronic pulmonary disease, Hct levels, albumin level, duration of operation, localization of the disease (colon or rectum), presence or absence of ileostomy or colostomy in operation, presence of hyperglycaemia, surgeon volume were compared whether it affected the development of superficial or deep surgical site infection. Results: All parameters were found to be significant for the development surgical site infection except sex and body mass index. Cut-off values were found for age; 63,5, operation time; 167.5 minutes, albumin; 3.05 and Hct; 33,15. Conclusion: We think that the probabality of surgical site infection after colorectal cancer surgery is high in patients older than 63,5 years, who had surgery longer than 167.5 minutes, preoperatively albumin value of 3.05 and Hct value of less than 33.15. If the patients diabetic, in ASA 3 risk group and have chronic lung disease and also cancer is located in the rectum and postoperative classification is Stage 3, ileostomy or colostomy is performed during operation it is evaluated together with the above cut-off values to determine whether superficial or deep surgical site infection we think that it is necessary to keep in mind that the possibility is high and to evaluate the signs and symptoms of the infection well. Keywords: Colorectal cancer, surgical site infection, predictive value ÖZ Amaç: Bu çalışmada kolorektal kanser nedeniyle opere edilen hastalarda cerrahi alan enfeksiyonu gelişmesine predispozisyon yaratan faktörler ve kesim değerleri ortaya konmak istendi Yöntem: 2015-2017 yılları arasında hastanemiz Genel Cerrahi bölümünde kolorektal kanser nedeniyle acil ya da elektif olarak opere edilmiş 86 hastaya ait datalar retrospektif olarak incelendi. Hastalara ait; yaş, cinsiyet, vücut kitle indexi, ASA skoru, kronik akciğer hastalığı varlığı, Hct seviyeleri, albümin düzeyi, operasyon süresi, hastalığın lokalizasyonu (kolon ya da rektum), operasyonda kolostomi ya da ileostomi açılıp açılmadığı, hiperglisemi varlığı, cerrah volümünün; yüzeyel ya da derin cerrahi alan enfeksiyonu gelişimini etkileyip etkilemediğinin değerlendirilmesi amaçlandı. Bulgular: Cinsiyet ve vücut kitle indexi dışında kalan tüm parametrelerin cerrahi alan enfeksiyonu gelişmesinde anlamlı olduğu tespit edildi. Yaş için; 63,5, operasyon süresi için; 167,5 dakika, albümin için; 3,05 ve HCT için de; 33,15 kesim değeri olarak bulundu. Sonuç: 63,5 yaşın üzerinde, ameliyatı 167,5 dakikadan daha uzun süren, ameliyat öncesi albumin değeri 3,05'in ve Hct değeri 33,15'in altında olan hastalarda ameliyat sonrası cerrahi alan enfeksiyonu gelişme ihtimalinin yüksek olduğunu düşünmekteyiz. Eğer kolorektal kanser nedeniyle opere edilecek ...

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A bundle of care to reduce colorectal surgical infections: an Australian experience

Cited by 74 publications

References 14 publications

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Predictive Factors for the Development of Surgical Site Infection After Colorectal Cancer Surgery

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