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 |
Surgical Site Infection, Colorectal Surgery, Bundled Care, Culture, Surgical Champion, Compliance
| [1] | Anderson, D. (2014). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control & Hospital Epidemiology, 35 (S2), pp. S66-S88. |
| [2] | Hewitt, D. (2017). Reducing colorectal surgical site infections: a novel, resident-driven, quality initiative. The American Journal of Surgery, 213 (1), pp. 36-42. |
| [3] | Cima, R. (2013). Colorectal Surgery Surgical Site Infection Reduction Program: A National Surgical Quality Improvement Program–Driven Multidisciplinary Single-Institution Experience. Journal of the American College of Surgeons, 216 (1), pp. 23-33. |
| [4] | Keenan, J., Speicher, P., Thacker, J., Walter, M., Kuchibhatla, M. and Mantyh, C. (2014). The Preventive Surgical Site Infection Bundle in Colorectal Surgery. JAMA Surgery, 149 (10), p. 1045. |
| [5] | Yamamoto, T., Morimoto, T., Kita, R., Masui, H., Kinoshita, H., Sakamoto, Y., Okada, K., Komori, J., Miki, A., Kondo, M., Uryuhara, K., Kobayashi, H., Hashida, H., Kaihara, S. and Hosotani, R. (2015). The preventive surgical site infection bundle in patients with colorectal perforation. BMC Surgery, 15 (1). |
| [6] | Zywot, A., Lau, C., Stephen Fletcher, H. and Paul, S. (2017). Bundles Prevent Surgical Site Infections After Colorectal Surgery: Meta-analysis and Systematic Review. Journal of Gastrointestinal Surgery, 21 (11), pp. 1915-1930. |
| [7] | Berenguer, C., Ochsner, M., Lord, S. and Senkowski, C. (2010). Improving Surgical Site Infections: Using National Surgical Quality Improvement Program Data to Institute Surgical Care Improvement Project Protocols in Improving Surgical Outcomes. Journal of the American College of Surgeons, 210 (5), pp. 737-741. |
| [8] | Tanner, J., Padley, W., Assadian, O., Leaper, D., Kiernan, M. and Edmiston, C. (2015). Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery, 158 (1), pp. 66-77. |
| [9] | Dellinger, E. (2005). Hospitals collaborate to decrease surgical site infections. The American Journal of Surgery, 190 (1), pp. 9-15. |
| [10] | Gustafsson, U., Scott, M., Hubner, M., Nygren, J., Demartines, N., & Francis, N. et al. (2018). Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery, 43 (3), 659-695. https://doi.org/10.1007/s00268-018-4844-y. |
| [11] | NHSN | CDC. (n.d.). Retrieved from https://www.cdc.gov/nhsn/index.html. |
| [12] | Borgert, M., Binnekade, J., Paulus, F., Goossens, A., & Dongelmans, D. (2017). A flowchart for building evidence-based care bundles in intensive care: based on a systematic review. International Journal for Quality In Health Care, 29 (2), 163-175. https://doi.org/10.1093/intqhc/mzx009. |
| [13] | Ban, K., Minei, J., Laronga, C., Harbrecht, B., Jensen, E., & Fry, D. et al. (2017). American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. Journal of the American College of Surgeons, 224 (1), 59-74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029. |
| [14] | Davis, C. (2017). Multi-Institution Analysis of Infection Control Practices Identifies the Subset That Impact Surgical Site Infection: A Texas Alliance for Surgical Quality Collaborative Project. Journal of the American College of Surgeons, 225 (4), pp. e110-e111. |
| [15] | Rudder, N., Borgert, A., Kallies, K., Smith, T., & Shapiro, S. (2019). Reduction of surgical site infections in colorectal surgery: A 10-year experience from an independent academic medical center. The American Journal of Surgery, 217 (6), 1089-1093. https://doi.org/10.1016/j.amjsurg.2018.11.010. |
| [16] | Kolarczyk, L. (2016). Implementation of an Enhanced Recovery After Surgery (ERAS) Clinical Pathway Using Lean Six Sigma Principles: A Framework for Ongoing Quality Improvement. SDRP Journal of Anesthesia & Surgery, 1 (2). |
| [17] | Vallance SR, Schell RH, Robbins RE. The practicing surgeon as a member of the quality-safety team. Am Surg 2006; 72: 1112–1114. |
| [18] | Stevenson, A., & Lindberg, C. A. (2013). New Oxford American dictionary. Oxford: Oxford University Press. |
| [19] | Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Annals of surgery. 2015; 261 (1): 92-6. |
| [20] | Borgert, M., Goossens, A. and Dongelmans, D. (2015). What are effective strategies for the implementation of care bundles on ICUs: a systematic review. Implementation Science, 10 (1). |
| [21] | Fry, D., Pine, M., Nedza, S., Locke, D., Reband, A., & Pine, G. (2016). Benchmarking hospital outcomes for improvement of care in Medicare elective colon surgery. The American Journal Of Surgery, 212 (1), 10-15. https://doi.org/10.1016/j.amjsurg.2016.01.037. |
| [22] | DeHaas, D., Aufderheide, S., Gano, J., Weigandt, J., Ries, J., & Faust, B. (2016). Colorectal surgical site infection reduction strategies. The American Journal of Surgery, 212 (1), 175-177. https://doi.org/10.1016/j.amjsurg.2016.04.001. |
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
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
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
Share This Article
Twitter
Linked In
Facebook
Copy
Download@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}
}
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 AU - Mark Horattas Y1 - 2021/12/07 PY - 2021 N1 - https://doi.org/10.11648/j.sjcm.20211004.19 DO - 10.11648/j.sjcm.20211004.19 T2 - Science Journal of Clinical Medicine JF - Science Journal of Clinical Medicine JO - Science Journal of Clinical Medicine SP - 131 EP - 137 PB - Science Publishing Group SN - 2327-2732 UR - https://doi.org/10.11648/j.sjcm.20211004.19 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 -
Information
Email: