Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

Abstract

INTRODUCTIONIn 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. METHODS A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. RESULTS Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). CONCLUSIONS The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs.

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

“…[31] Overall SSI rates were 25.2% during the pre-intervention and 26.6% during the post-intervention time periods (p=0.82). Similarly, Tanner et al reported a non-statistically significant difference between rates before and after bundle implementation (24% baseline vs 28% bundled group, p≥0.05) [16]. …”

Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures

“…The success of bundles appears to be dependent, to some extent, on compliance . A bundled approach, including pretheater nasal and/or skin decolonization has been used to reduce the risk of staphylococcal infection for cardiac and orthopedic surgery in Australasia .…”

“…9 The success of bundles appears to be dependent, to some extent, on compliance. 10 A bundled approach, including pretheater nasal and/or skin decolonization has been used to reduce the risk of staphylococcal infection for cardiac and orthopedic surgery in Australasia. 11 A presurgical bundle used in children undergoing surgical procedures reduced SSI rates and the correct timing of preoperative prophylactic antibiotics from 35% to 79% played a major role in that improvement.…”

The development of a staphylococcus aureus four antigen vaccine for use prior to elective orthopedic surgery

“…Adherence to bundles is also resource intensive for clinical staff, and poor patient compliance has been implicated in lower than expected effectiveness. 29 In addition, routine use of antibiotic prophylaxis and nasal decolonization agents such as mupirocin, have resulted in selection pressure on colonizing strains. 30,31 Reports of increasing mupirocin resistance are of serious concern 32,33 and the promotion of mupirocin resistance may also aid in the spread of multidrug resistance through co-selection with other resistance genes 34 (e.g.…”