Surgical-Site Infection Prevention After Hysterectomy: Use of a Consensus Bundle to Guide Improvement

Abstract

Hysterectomy is one of the most commonly performed surgeries in women. Surgical-site infections (SSI) after hysterectomy can lead to increased morbidity and mortality as well as readmission, which is associated with increased costs for health systems. The aim of the project was to improve standardization of preoperative education on infection prevention and incorporate the use of preoperative chlorhexidine (CHG) bathing for patients undergoing hysterectomy to decrease rates of SSI. Data on SSI after hysterectomy were reviewed. Tracer methodology was used to identify gaps in the preoperative process by comparing the current process to the Council on Patient Safety in Women's Health Care Patient Safety Bundle “Prevention of Surgical Site Infection after Gynecologic Surgery.” After implementation, survey data were collected on adherence to the washing protocol, and SSI data were monitored. Survey results reflected high compliance with the CHG washing protocol, provision of patient education, and overall patient satisfaction with the process. Before implementation in 2016, we reported 8 deep or organ/space SSI to the National Healthcare Safety Network. After implementation in 2018, we reported 3 deep or organ/space SSI. Standardizing infection prevention processes to align with safety bundles improves the quality of care provided to patients.

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

“…Figure 2 outlines the results of the 26-study meta-analysis exploring the use of an SSI prevention care bundle versus usual care among surgical patients 19–25,27–36,38–45,48 . The I 2 is 83%, indicating there is considerable heterogeneity among the studies; therefore, a random-effects model was used for the meta-analysis.…”

“…Figure 4 outlines the results of the meta-analysis of five studies exploring the use of an SSI prevention care bundle for gynecologic surgery versus usual care. 20,21,23,38,39 The I 2 is 23%, indicating low heterogeneity among the studies; therefore, a fixed-effects model was used for the meta-analysis. Again, there is a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 2% [40/2,656], care bundle group, vs 6% [198/3,289], usual care).…”

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal‐Approach Hysterectomy at a Midwestern Teaching Hospital

“…Results of several QI projects reflect improved SSI rates after implementing SSI‐prevention bundles 26‐29 . At one academic medical center, the incidence of SSIs after hysterectomy decreased from 4.51% before implementation of a bundle to 1.87% after implementation ( P = .001) 26 .…”

A Retrospective Study from 2 Tertiary Hospitals in China to Evaluate the Risk Factors for Surgical Site Infections After Abdominal Hysterectomy in 188 Patients

“…Among the different types of hysterectomy, laparoscopic hysterectomy results in lower rates of surgical site infections compared with abdominal hysterectomy and vaginal hysterectomy [ 6 ]. Surgical site infections not only increase medical expenses, including the surgery and drug costs [ 7 ], but also increase the morbidity, mortality, and readmission rates [ 1 ]. Therefore, this retrospective study from 2 grade A tertiary hospitals in China aimed to evaluate the risk factors for postoperative surgical site infections in 188 patients undergoing abdominal hysterectomy between September 2013 and June 2021.…”