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Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence

Received: 4 November 2021     Accepted: 25 November 2021     Published: 7 December 2021
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Abstract

Background: Surgical site infections (SSI) are an undesirable surgical complication that leads to negative patient and system outcomes. SSI risk correlates with various intrinsic (patient) and extrinsic (system) factors. Colorectal surgeries are especially susceptible. In 2013, the incidence of postoperative colorectal SSI rates was noted to be elevated at our institution with respect to national benchmarks. We developed and implemented an evidence based Colorectal Bundle (CRB) as our targeted intervention to reduce SSI. Methods: A multidisciplinary team was formed to develop and implement a CRB. The bundle was created using interventions established in the literature while also accounting for institutional biases. After a period of implementation, data was then analyzed using baseline and post implementation statistics. Additionally, infection rates were compared to national expected incidences using two national programs, the NSQIP and NHSN. Bundle compliance was encouraged over time to achieve sustained results. Results: We performed a total of 519 colorectal surgeries over a span of two and a half years and limited our infection rate to only 12 cases (2.3%). This was a significant reduction in SSI rates (RR 0.28, p < 0.001) and according to NSQIP, placed our system in the top decile with respect to SSI incidence. Conclusions: Implementation of our CRB resulted in a sustained decrease in SSI rates with respect to colorectal surgeries. We hope this manuscript can serve as a recipe for change. We highlight steps that were crucial to the success of our CRB from inception onward. We believe these key elements include the presence of a surgical champion, multi departmental buy-in, and continued compliance leading to a culture of excellence.

Published in Science Journal of Clinical Medicine (Volume 10, Issue 4)
DOI 10.11648/j.sjcm.20211004.19
Page(s) 131-137
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Surgical Site Infection, Colorectal Surgery, Bundled Care, Culture, Surgical Champion, Compliance

References
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Cite This Article
  • APA Style

    Christopher Wolff, Stephen Brandstetter, Wanda Mullins, Mark Horattas. (2021). Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence. Science Journal of Clinical Medicine, 10(4), 131-137. https://doi.org/10.11648/j.sjcm.20211004.19

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    ACS Style

    Christopher Wolff; Stephen Brandstetter; Wanda Mullins; Mark Horattas. Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence. Sci. J. Clin. Med. 2021, 10(4), 131-137. doi: 10.11648/j.sjcm.20211004.19

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    AMA Style

    Christopher Wolff, Stephen Brandstetter, Wanda Mullins, Mark Horattas. Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence. Sci J Clin Med. 2021;10(4):131-137. doi: 10.11648/j.sjcm.20211004.19

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  • @article{10.11648/j.sjcm.20211004.19,
      author = {Christopher Wolff and Stephen Brandstetter and Wanda Mullins and Mark Horattas},
      title = {Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence},
      journal = {Science Journal of Clinical Medicine},
      volume = {10},
      number = {4},
      pages = {131-137},
      doi = {10.11648/j.sjcm.20211004.19},
      url = {https://doi.org/10.11648/j.sjcm.20211004.19},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20211004.19},
      abstract = {Background: Surgical site infections (SSI) are an undesirable surgical complication that leads to negative patient and system outcomes. SSI risk correlates with various intrinsic (patient) and extrinsic (system) factors. Colorectal surgeries are especially susceptible. In 2013, the incidence of postoperative colorectal SSI rates was noted to be elevated at our institution with respect to national benchmarks. We developed and implemented an evidence based Colorectal Bundle (CRB) as our targeted intervention to reduce SSI. Methods: A multidisciplinary team was formed to develop and implement a CRB. The bundle was created using interventions established in the literature while also accounting for institutional biases. After a period of implementation, data was then analyzed using baseline and post implementation statistics. Additionally, infection rates were compared to national expected incidences using two national programs, the NSQIP and NHSN. Bundle compliance was encouraged over time to achieve sustained results. Results: We performed a total of 519 colorectal surgeries over a span of two and a half years and limited our infection rate to only 12 cases (2.3%). This was a significant reduction in SSI rates (RR 0.28, p Conclusions: Implementation of our CRB resulted in a sustained decrease in SSI rates with respect to colorectal surgeries. We hope this manuscript can serve as a recipe for change. We highlight steps that were crucial to the success of our CRB from inception onward. We believe these key elements include the presence of a surgical champion, multi departmental buy-in, and continued compliance leading to a culture of excellence.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Preventing Surgical Site Infections and Colorectal Surgery: Creating an Interdisciplinary Culture of Safety and Excellence
    AU  - Christopher Wolff
    AU  - Stephen Brandstetter
    AU  - Wanda Mullins
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    Y1  - 2021/12/07
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    T2  - Science Journal of Clinical Medicine
    JF  - Science Journal of Clinical Medicine
    JO  - Science Journal of Clinical Medicine
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    EP  - 137
    PB  - Science Publishing Group
    SN  - 2327-2732
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    AB  - Background: Surgical site infections (SSI) are an undesirable surgical complication that leads to negative patient and system outcomes. SSI risk correlates with various intrinsic (patient) and extrinsic (system) factors. Colorectal surgeries are especially susceptible. In 2013, the incidence of postoperative colorectal SSI rates was noted to be elevated at our institution with respect to national benchmarks. We developed and implemented an evidence based Colorectal Bundle (CRB) as our targeted intervention to reduce SSI. Methods: A multidisciplinary team was formed to develop and implement a CRB. The bundle was created using interventions established in the literature while also accounting for institutional biases. After a period of implementation, data was then analyzed using baseline and post implementation statistics. Additionally, infection rates were compared to national expected incidences using two national programs, the NSQIP and NHSN. Bundle compliance was encouraged over time to achieve sustained results. Results: We performed a total of 519 colorectal surgeries over a span of two and a half years and limited our infection rate to only 12 cases (2.3%). This was a significant reduction in SSI rates (RR 0.28, p Conclusions: Implementation of our CRB resulted in a sustained decrease in SSI rates with respect to colorectal surgeries. We hope this manuscript can serve as a recipe for change. We highlight steps that were crucial to the success of our CRB from inception onward. We believe these key elements include the presence of a surgical champion, multi departmental buy-in, and continued compliance leading to a culture of excellence.
    VL  - 10
    IS  - 4
    ER  - 

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Author Information
  • Cleveland Clinic Akron General, Akron, USA

  • Cleveland Clinic Akron General, Akron, USA

  • Cleveland Clinic Akron General, Akron, USA

  • Cleveland Clinic Akron General, Akron, USA

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