Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection.

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Evaluation of the Bundle "Zero Surgical Site Infection" to Prevent Surgical Site Infection in Vascular Surgery.

BACKGROUND: To compare the incidence of surgical site infections (SSIs) before and after the implementation of a bundle of care called "Zero Surgical Site Infection." Secondary goals included estimating measures of association and their potential impact, determining care management indicators in vascular surgery, and evaluating the level of compliance with the bundle. METHODS: This is a prospective observational study with a historic control group. The bundle included (1) removal of body hair with clippers; (2) preoperative showering with chlorhexidine soap; (3) preparation of the surgical field with alcoholic chlorhexidine 2%; (4) adequacy of antimicrobial prophylaxis; (5) intraoperative and (6) postoperative glycemic and central temperature control. Student's t-test and chi-squared test were performed. Relative risk, attributable risk, number needed to treat, and preventable fraction were used as association and impact measures. RESULTS: In total, 192 patients were included. The overall incidence of SSI was 8.85%; the preventive fraction was 59.1%. The rate of incidence of SSI for clean surgery was reduced from 4.9% to 0% (P = 0.127), whereas the average hospital stay decreased from 22.38 to 13.70 days (P = 0.002). Concerning contaminated surgery, significant differences were found in the rate of incidence of SSI (33.3% vs. 13.9%, P = 0.035). Compliance with the bundle of preoperative and intraoperative measures exceeded 95% and almost reached 50%, respectively. Compliance with the bundle of postoperative measures reached 25%. CONCLUSIONS: This bundle has demonstrated to be effective in reducing the incidence of SSI in vascular surgery. The publication of these initial results should encourage the implementation of this bundle at national level.