Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery

Ruíz-Tóvar, Jaime; Llavero, Carolina; Morales, Vicente; Gamallo, Carlos

doi:10.1007/s00464-018-6069-4

Cited by 13 publications

(25 citation statements)

References 30 publications

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“…The first site of infection, in terms of timing, is the superficial incision [2]. We must not underestimate this problem because it has a significant impact on morbidity, mortality, length of hospital stay and overall costs [3]. There are many ways to reduce the rate of SSIs both peri-and intra-operatively.…”

Section: Introductionmentioning

confidence: 99%

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Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

et al. 2020

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Section: Introductionmentioning

confidence: 99%

“…SSIs mostly occur in patients who underwent abdominal surgery; for this reason, the general surgeon deals with this important clinical problem on a daily basis [3].…”

Section: Introductionmentioning

confidence: 99%

Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

et al. 2020

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“…Despite the heterogeneity there was significant reduction in the risk of SSIs by 46% (RR=0.54; 95% CI, 0.46-0.64; p<.00001, I 2 =73%) (Figure 2). 22 of the 25 studies had a statistically significant decrease in overall SSI rates following bundle implementation [16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Two studies showed no effect [21,40] and Anthony, et al 2011 [15] reported a statistically significant increase in SSI after bundle implementation.…”

Section: Wound Bundle and Their Effect On Surgical Site Infection Ratesmentioning

confidence: 99%

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

2022

J Surg

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Background: Surgical Site Infections (SSI) are a major source of post-operative complications and potentially affect oncological outcomes. Reducing SSI is multi-factorial, best served by the additive affect of individual wound bundle elements. With changing strategies and novel innovations ongoing meta-analyses are needed to inform current practice. This study undertook a meta-analysis of existing wound bundles impact on SSI in colorectal surgery.Methods: A PROSPERO-registered (ID: CRD42018104923) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using databases PubMed, Scopus and Web of Science, from January 2008 to July 2018, was undertaken. Articles scoring ≥ 17 using Methodological Index for non-randomised Studies (MINORS) criteria were included.Results: 5,104 articles were reviewed, and 27 studies met inclusion criteria with a total cohort of 23851 patients. Wound bundles significantly decreased SSI rates from 17.5% to 9.7%. Sub-analysis identified greatest impact on superficial SSI (risk reduction of 54%; p<0.00001) and organ-space infections (risk reduction 42%; p=0.0006).Wound bundles also significantly reduced hospital length of stay (MD = −0.79; p<0.00001). Conclusions:Colorectal wound bundles significantly reduce the risk of SSI and length of hospital stay. They should become routine in colorectal surgery. Future work encompasses the need for standardisation of wound complications, standardised follow-up of patients and internationally agreed research definitions.

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“…Most studies (n = 33) reported overall SSI incidence ( Table 1). Several studies did not report overall SSI incidence but did report superficial SSI incidence (n = 4), 14,[38][39][40] and/or organ-space SSI incidence (n = 3) 41,42,51 (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…(2) normothermia maintenance in 32 studies (80%); (3) perioperative glucose control in 22 studies (55%); (4) appropriate hair removal in 20 studies (50%); (5) mechanical and oral bowel preparation in 18 studies (45%); (6) preoperative bathing with chlorhexidine in 16 studies (40%); (7) standardized postoperative dressing removal and wound care in 16 studies (40%); (8) wound closure protocol including glove with or without gown change and separate instrument tray in 15 studies (38%); (9) use of wound protectors in 11 studies (28%); (10) use of supplemental oxygen postoperatively in 7 studies (18%); (11) cutaneous antisepsis with a solution containing chlorhexidine gluconate and isopropyl alcohol in 6 studies (15%); (12) preoperative smoking cessation in 4 studies (10%); (13) wearing appropriate surgical attire, restricted to the operating room (OR) in 2 studies (5%). Other interventions included minimizing OR traffic, 19,20,22,46,51 peritoneal lavage with antibiotics, 14,43 wound irrigation with antibiotic solution 15,26 or with saline before closure, 16,23,29,31,40 postoperative daily chlorhexidine showers, 18,21,32 and daily wound cleaning with chlorhexidine. 32,46,51 Adherence to colorectal SSI prevention bundles Adherence to colorectal SSI prevention bundles was reported in 28 studies (70%).…”

Section: Composition Of Colorectal Infection Prevention Bundlesmentioning

confidence: 99%

Colorectal bundles for surgical site infection prevention: A systematic review and meta-analysis

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Abad

Baubie

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:In colorectal surgery, the composition of the most effective bundle for prevention of surgical site infections (SSI) remains uncertain. We performed a meta-analysis to identify bundle interventions most associated with SSI reduction.Methods:We systematically reviewed 4 databases for studies that assessed bundles with ≥3 elements recommended by clinical practice guidelines for adult colorectal surgery. The main outcome was 30-day postoperative SSI rate (overall, superficial, deep, and/or organ-space).Results:We included 40 studies in the qualitative review, and 35 studies (54,221 patients) in the quantitative review. Only 3 studies were randomized controlled trials. On meta-analyses, bundles were associated with overall SSI reductions of 44% (RR, 0.57; 95% CI, 0.48–0.65); superficial SSI reductions of 44% (RR, 0.56; 95% CI, 0.42–0.75); deep SSI reductions of 33% (RR, 0.67; 95% CI, 0.46–0.98); and organ-space SSI reductions of 37% (RR, 0.63; 95% CI, 0.50–0.81). Bundle composition was heterogeneous. In our meta-regression analysis, bundles containing ≥11 elements, consisting of both standard of care and new interventions, demonstrated the greatest SSI reduction. Separate instrument trays, gloves with and without gown change for wound closure, and standardized postoperative dressing change at 48 hours correlated with the highest reductions in superficial SSIs. Mechanical bowel preparation combined with oral antibiotics, and preoperative chlorhexidine showers correlated with highest organ-space SSI reductions.Conclusions:Preventive bundles emphasizing guideline-recommended elements from both standard of care as well as new interventions were most effective for SSI reduction following colorectal surgery. High clinical-bundle heterogeneity and low quality for most observational studies significantly limit our conclusion.

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Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery

Cited by 13 publications

References 30 publications

Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

Colorectal bundles for surgical site infection prevention: A systematic review and meta-analysis

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