Optimizing Value of Colon Surgery in Michigan

Jaffe, Todd A.; Meka, Arjun P.; Semaan, Daniel Z.; Okoro, Uchenna; Hwang, Charles; Papin, Joseph; Mullard, Andrew J.; Campbell, Darrell A.; Englesbe, Michael J.

doi:10.1097/sla.0000000000001880

Cited by 19 publications

(12 citation statements)

References 27 publications

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“…With regard to bundle implementation, an inverse relationship between compliance rates and SSI rates has been previously demonstrated. 18 Our overall compliance rate with the OSI prevention bundle was 62.5%. Compliance rates with individual elements of the bundle ranged from 84.9% to 100%.…”

Section: Discussionmentioning

confidence: 81%

Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery

et al. 2021

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BackgroundSurgical site infections (SSIs) are morbid and costly complications after elective colorectal surgery. SSI prevention bundles have been shown to reduce SSI in colorectal surgery, but their impact on organ space infections (OSI) is variable. Adoption of an evidence-based practice without an implementation strategy is often unsuccessful. Our aim was to successfully implement an OSI prevention bundle and to achieve a cost-effective reduction in OSI following elective left-sided colorectal operations.MethodsThe Translating Research into Practice model was used to implement an OSI prevention bundle in all patients undergoing elective left-sided colorectal resections by a single unit from November 2018 to September 2019. The new components included oral antibiotics with mechanical bowel preparation, when required, and use of impermeable surgical gowns. Other standardised components included alcoholic chlorhexidine skin preparation, glove change after bowel handling prior to wound closure with clean instruments. The primary outcome was OSI. Secondary outcomes included bundle compliance, unintended consequences and total patient costs. Outcomes were compared with all patients undergoing elective left-sided colorectal resections at the same institution in 2017.ResultsElective colorectal resections were performed in 173 patients across two cohorts. The compliance rate with bundle items was 63% for all items and 93% for one omitted item. There was a reduction in OSI from 12.9% (11 of 85) to 3.4% (3 of 88, p<0.05) after implementation of the OSI prevention bundle. The average cost of an OSI was $A36 900. The estimated savings for preventing eight OSIs by using the OSI bundle in the second cohort was $A295 198.ConclusionSuccessful implementation of an OSI prevention bundle was associated with a reduced rate of OSI after elective colorectal surgery. The OSI bundle and its implementation were cost-effective. Further study is required to investigate the sustainability of the OSI prevention bundle.

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Section: Discussionmentioning

confidence: 81%

Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery

et al. 2021

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“…Previous studies showed that a bundle of infection control measures was shown to be extremely successful in reducing catheter-related blood stream infections [2] and ventilatorassociated pneumonia [10]. Jaffe et al reported that SSI rates is 0.9% when there is a compliance to all care bundle components and the SSI rate is 17.9% when bundle adherence was lowest [11]. Moreover, Richards et al stated that the application of evidence-based practices to reduce catheter-associated urinary tract infections decrease the infection ratio from 2.34 to an infection ratio of less than 1.0 [12].…”

Section: Original Research Articlementioning

confidence: 99%

The Compliance of Healthcare Providers to Care Bundles in a Tertiary Hospital in Riyadh Region

Ahmed

Haseeb

Khan

2021

JPRI

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This study aimed to describe the compliance rate of healthcare providers to care bundles in a tertiary hospital in Riyadh Region. The overall compliance rate of hand hygiene was low (less than 80%). The overall compliance rates of urinary catheter bundle, central line insertion bundle, and central line maintenance bundle were high (more than 95 %). The compliance rate to SSI bundle, ventilator bundle, safe injection practice, and using personal protective equipment was high. It is important to increase the compliance rate of the care bundles elements to 95 percent or greater, particularly the compliance to hand hygiene to improve patient care.

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“…23,26,45 Adherence to preoperative bathing with chlorhexidine and/or use of chlorhexidine-impregnated wipes ranged between 89% and 92%. 16,52 Three studies reported SSI incidence by bundle adherence: Jaffe et al 27 observed an overall SSI rate of 0.9% versus 16% when there was adherence to all 6 bundle elements versus only 0-2 bundle elements, respectively. Vu et al 34 reported an overall SSI rate of 4.5% versus 6.5% in the highest versus lowest adherence quartile, respectively (P = .049).…”

Section: Composition Of Colorectal Infection Prevention Bundlesmentioning

confidence: 99%

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

Pop-Vicas

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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Optimizing Value of Colon Surgery in Michigan

Abstract: A colectomy perioperative care bundle in Michigan is associated with improved value of surgical care. We will expand efforts to implement perioperative care bundles in Michigan to improve outcomes and reduce costs.

Cited by 19 publications

References 27 publications

Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery

Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery

The Compliance of Healthcare Providers to Care Bundles in a Tertiary Hospital in Riyadh Region

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

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