The DISINFECT initiative: Decreasing the incidence of surgical INFECTions in gynecologic oncology

Abstract

Background-Surgical site infections (SSI) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.

The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis

“…– 15 , 17 –44,46–49,51–59,61–120,122–133,135–140,142–152 The final group of articles also included 3 randomized controlled trials (2.1%), 121,134,141 2 cluster-randomized controlled trials (1.4%), 50,60 and 1 time-series analysis (0.7%). 45 Moreover, 109 studies (75.7%) were performed in high income settings, 8 , 10 – 12 , 14 , 15 , 17 , 18 , 20 , 21 , 23 – 30 , 34 –45,47,48,50–53,55–57,60,64–68,72–77,79–82,85–91,93–97,99–101,103–120,122,124–131,134,138,140,143,144,146–152 26 studies (18.1%) were conducted in upper middle income settings, 9 , 13 , 22 , 31 – 33 ,59,61–63,69–71,78,92,98,102,121,123,132,133,135,137,139,141,145 and 9 studies (6.3%) were conducted in lower middle income countries 19 Fig.…”

“…S3a) 9 11 , 14 , 15 , 17 , 21 , 23 , 29 , 37 , 39 ,51,55,56,65,67,72,77,80,86,88,91,93,94,100,104,105,110,114,117,118,124,130,134,145,147,150 The pooled RR of the before-and-after studies was 0.461 (95% CI, 0.389–0.546), with an overall heterogeneity of I 2 =66.4%. A significant increase of SSI rates associated with a multifaceted intervention (RR, 1.565; 95% CI, 1.015–2.412) was reported in 1 RCT.…”

A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications

“…5,18 Another possible limitation in the study was the identification used. [19][20][21][22] Notably, SSI rates from the NHSN tend to be lower than those from other sources. Although this might have led to underreporting of the infection rates, the relative decrease in SSI would not be affected.…”

“…This system might miss infections that were treated solely on an outpatient basis or superficial SSIs that did not have a microbial culture diagnosis. Studies have shown discrepancies in a hospital’s SSI rates based on the data‐collecting system used 19–22 . Notably, SSI rates from the NHSN tend to be lower than those from other sources.…”

Enhanced recovery after surgery: implementing a new standard of surgical care

“…33 A prospective study of patients undergoing gynecologic surgery found reduced infections at surgical sites and reduced costs among those who used a chlorhexidine wash on the night before surgery compared with a retrospective cohort. 34…”