Effect of a surgical care bundle on the incidence of surgical site infection in colorectal surgery: a quasi-experimental intervention

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention.

BACKGROUND: Surgical site infections (SSI) have an important impact on morbidity and mortality. OBJECTIVE: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. METHODS: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). RESULTS: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. CONCLUSIONS: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Adequacy of antibiotic prophylaxis protocol in appendectomies in children.

OBJECTIVE: To assess compliance of antibiotic prophylaxis in surgery for acute appendicitis in children and its effect on surgical site infection. METHODS: We carried out a prospective cohort study to evaluate compliance of antibiotic prophylaxis in appendectomies in children. An assessment of the level of compliance with prophylaxis was made, as well as the causes of non-compliance. The effect of non-compliance of antibiotic prophylaxis on the incidence of surgical site infection was studied with the adjusted relative risk (RR) with a backstep logistic regression model. RESULTS: The study included a total of 412 patients. Antibiotic prophylaxis was indicated in 348 patients, and administered in 95.7% of cases, with an overall protocol compliance of 90.7%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 2.7%. No relationship was found between inadequate prophylaxis compliance and infection (RR: 1.01; 95% confidence interval: 0.95-1.11; p = 0.61). CONCLUSIONS: Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate.

OBJETIVO: Evaluar la adecuación de la profilaxis antibiótica en la cirugía de apendicitis aguda en niños y su efecto en la infección del sitio quirúrgico. MÉTODO: Estudio de cohortes prospectivo para evaluar la adecuación al protocolo de la profilaxis antibiótica en apendicectomías en población infantil. Se evaluaron la administración de la profilaxis y las causas de la inadecuación. Se estudió el efecto de la inadecuación en la incidencia de infección del sitio quirúrgico con el riesgo relativo (RR) ajustado con un modelo de regresión logística por pasos hacia atrás. RESULTADOS: Se estudiaron 412 pacientes. La profilaxis antibiótica estaba indicada en 348 pacientes y se administró en el 95.7% de los casos, con una adecuación global al protocolo del 90.7%. La causa principal del incumplimiento fue la hora de inicio. La incidencia acumulada de infección del sitio quirúrgico fue del 2.7%. No se encontró relación entre la adecuación de la profilaxis y la infección del sitio quirúrgico (RR: 1.01; intervalo de confianza del 95%: 0.95-1.11; p = 0.61). CONCLUSIONES: La adecuación de la profilaxis antibiótica fue alta, pero puede mejorarse. No se encontró relación entre la adecuación de la profilaxis antibiótica y la incidencia de infección del sitio quirúrgico.

Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo / Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study

INTRODUCCIÓN: La infección de sitio quirúrgico (ISQ) es la principal causa de infección nosocomial. El objetivo de este trabajo fue estudiar la incidencia de ISQ y evaluar los factores de riesgo que la determinan en pacientes intervenidos de cirugía de recto. MÉTODOS: Estudio de cohortes prospectivo, realizado de enero del 2013 a diciembre del 2016. Se recogieron variables relacionadas con el paciente, la intervención quirúrgica y la infección. Se calculó la incidencia de infección tras un periodo máximo de 30 días de incubación. Se evaluó el efecto de los diferentes factores de riesgo en la infección con la odds ratio ajustada con un modelo de regresión logística. RESULTADOS: El estudio incluyó a 154 pacientes, con una edad media de 69,5±12 años. Las comorbilidades más habituales fueron diabetes mellitus (24,5%), enfermedad pulmonar obstructiva crónica (17%) y obesidad (12,6%). La incidencia global de ISQ durante el periodo de seguimiento fue de 11,9% (IC95%: 7,8-17,9) y el microorganismo más frecuente fue Escherichia coli (57,9%). Los factores de riesgo asociados a la infección quirúrgica en el análisis univariante fueron la transfusión sanguínea, el uso de drenajes y la administración de fármacos vasoactivas (p < 0,05). CONCLUSIONES: La incidencia de ISQ en cirugía de recto fue baja. Es muy importante evaluar la incidencia de infección y tratar de identificar los posibles factores de riesgo de infección. Recomendamos la implantación de programas prospectivos de vigilancia y control de la infección hospitalaria

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5 ± 12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs

[Efecto de un Plan de Mejora de Calidad y Seguridad Clínica en la incidencia de infección de sitio quirúrgico en apendicectomía. Estudio cuasi-experimental]. / Effect of a Plan for Quality Improvement and Clinical Safety in the incidence of surgical site infections in appendectomy. A quasi-experimental study.

OBJETIVO: Las infecciones de sitio quirúrgico se pueden evitar y los programas de control basados en paquetes de medidas preventivas son eficaces para reducir su incidencia. El objetivo de este estudio fue evaluar el efecto de un Plan de Mejora de Calidad y Seguridad Clínica del paciente intervenido de apendicectomía en la incidencia de infección del sitio quirúrgico. MÉTODO: Se realizó un estudio cuasi-experimental con análisis antes y después de la introducción de un Plan de Calidad y Seguridad Clínica. Se incluyeron pacientes intervenidos de apendicectomía. Se estudió la incidencia de infección del sitio quirúrgico durante los 30 días posteriores a la cirugía (periodo máximo de incubación de infección quirúrgica). Se evaluó el efecto de la intervención con la odds ratio (OR) ajustada con un modelo de regresión logística. RESULTADOS: Se incluyeron 606 pacientes, 267 en el periodo 2009-2010 (antes del plan) y 339 durante 2012-2013 (después del plan). La incidencia de infección del sitio quirúrgico descendió después del plan del 6 al 5.6% (OR: 0.72; intervalo de confianza del 95%: 0.33-1.56; p = 0.839). Hubo mayor cumplimiento de la profilaxis antibiótica, de la preparación prequirúrgica y de la adherencia a la higiene de manos tras la introducción de las medidas. CONCLUSIONES: Aunque la reducción de la incidencia de infección del sitio quirúrgico no presentó diferencias estadísticamente significativas tras las medidas adoptadas, se ha conseguido mejorar la administración de la profilaxis antibiótica, la adherencia a la higiene de manos y la preparación prequirúrgica. OBJECTIVE: Surgical site infections can be prevented. Control programs based on care bundle have proven to be effective in reducing its incidence. The objective of this study was to assess the effectiveness of a Plan for Quality Improvement and Clinical Safety in preventing the incidence of surgical site infection in patients undergoing appendectomy. METHOD: A quasi-experimental study was designed for analysis before and after the introduction of a Plan for Quality and Clinical Safety. Patients undergoing appendectomy were included. The incidence of surgical site infection was studied within 30 days from the time of surgery (maximum incubation period of surgical site infection). The effectiveness of the intervention was evaluated using the odds ratio (OR) adjusted with a logistic regression model. RESULTS: A total of 606 patients were included, of which 267 were operated in the period 2009-2010 (before the plan) and 339 in 2012-2013 (after the plan). The incidence of surgical site ­infection decreased after the plan from 6 to 5.6% (OR: 0.72; 95% confidence interval: 0.33-1.56; p = 0.839). There was greater compliance of antibiotic prophylaxis, preoperative preparation and adherence to hand hygiene after the introduction of the measures. CONCLUSIONS: Although the reduction in the incidence of surgical site infection after the measures adopted did not show statistical significant differences, important progress has been made in the compliance of antibiotic prophylaxis, adherence to hand hygiene and in the preoperative preparation.

Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study. / Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo.

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5±12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs.

Rates of Surgical Site Infection in Cholecystectomy: Comparison between a University Teaching Hospital, Madrid Region, Spain, and USA Rates.

BACKGROUND: There are many factors that can influence surgical site infections (SSI) in cholecystectomies. Incidence of cholecystectomy SSI was studied and compared with the incidence in Madrid Region, Spain, and the United States. METHODS: A prospective cohort study was conducted which included all patients who underwent gallbladder surgery for 5 consecutive years, at the Alcorcón Foundation University Teaching Hospital. SSI incidence rate was calculated. An association between risk factors and SSI incidence was assessed with the relative risk (RR). Infection rates were compared to those in the Madrid Region and to the overall Spanish and United States rates using the standardized infection ratio (SIR). RESULTS: The study included 1532 patients. Cumulative overall SSI was 1.96% (95% confidence interval [CI]: 1.3-2.7). The SIR was 0.89 with respect to the Madrid Region, 0.77 with respect to Spain's rate, and 1.77 with respect to the United States' rate. A laparoscopic route protected against infection (RR = 0.43; 95% CI: 0.2-0.9). Razor shaving in surgical preparation, duration of surgery, and neoplasm increased SSI incidence. CONCLUSIONS: SSI incidence rates among cholecystectomized patients at our hospital are higher than rates in the United States. A laparoscopic route protected against SSI.

Evaluación de la adecuación de la profilaxis antibiótica en la cirugía de recto / Assessment of antibiotic prophylaxis adequacy in rectal surgery

Introducción. La profilaxis antibiótica es la herramienta más adecuada para la prevención de la infección de localización quirúrgica (ILQ), por lo que es esencial la elaboración de protocolos y valoración de su seguimiento. En este estudio se evaluó el cumplimiento del protocolo de profilaxis antibiótica en la cirugía de recto y el efecto de su adecuación en cuanto a la prevención de la ILQ. Material y métodos. Se realizó un estudio de cohortes prospectivo, desde el 1 de enero de 2009 al 31 de diciembre de 2015. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y sus causas de incumplimiento en cirugía rectal. Se estudió la incidencia de ILQ tras un período máximo de 30 días de incubación. Para evaluar el efecto del incumplimiento de la profilaxis sobre la ILQ se utilizó el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados. El estudio incluyó un total de 244 pacientes. Se infectaron 20 pacientes, con una incidencia acumulada de ILQ del 8,2% (IC95%: 4,8-11,6). La profilaxis antibiótica estaba indicada en la totalidad de pacientes y se administró en el 98% de los casos, con un cumplimiento general del protocolo del 92,5%. La causa principal de incumplimiento fue la elección del antibiótico 55,6% (n=10). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR=0,58; IC95% 0,10-4,10 (p>0,05). Conclusiones. El cumplimiento de la profilaxis antibiótica fue muy elevado. No se halló relación entre la adecuación de la profilaxis y la incidencia de infección de localización quirúrgica en cirugía de recto (AU)

Introduction. Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection (SSI), so the development of guidelines and assessment of its monitoring is essential. In this study protocol compliance of antibiotic prophylaxis in rectal surgery and the effect of its adequacy in terms of prevention of SSI was assessed. Material and methods. Prospective cohort study was conducted from 1 January 2009 to 30 December 2015. The degree of compliance with antibiotic prophylaxis and causes of non-compliance in rectal surgery was evaluated. The incidence of SSI was studied after a maximum period of 30 days of incubation. To assess the effect of prophylaxis non-compliance on SSI the relative risk (RR) adjusted with the aid of a logistic regression model was used. Results. The study covered a total of 244 patients. The patients infected reached 20 cases with a SSI cumulative incidence of 8.2% (CI95%: 4.8-11.6). Antibiotic prophylaxis was indicated in all patients and was administered in 98% of cases, with an overall protocol compliance 92.5%. The principal cause of non-compliance was the choice of antibiotic 55.6% (n=10). The effect of inadequacy of antibiotic prophylaxis on surgical infection was RR=0.58, CI95%: 0.10-4.10 (P>0.05). Conclusions. Compliance with antibiotic prophylaxis was high. No relationship between the adequacy of prophylaxis and incidence of surgical site infection in rectal surgery was found (AU)

[Effect of compliance with an antibiotic prophylaxis protocol in surgical site infections in appendectomies. Prospective cohort study]. / Efecto de la adecuación a protocolo de la profilaxis antibiótica en la incidencia de infección quirúrgica en apendicectomías. Estudio de cohortes prospectivo.

BACKGROUND: Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection. This study assessed compliance with antibiotic prophylaxis in surgery for acute appendicitis, and the effect of this compliance on surgical site infection. MATERIAL AND METHODS: Prospective cohort study to evaluate compliance with antibiotic prophylaxis protocol in appendectomies. An assessment was made of the level of compliance with prophylaxis, as well as the causes of non-compliance. The incidence of surgical site infection was studied after a maximum incubation period of 30 days. The relative risk adjusted with a logistic regression model was used to assess the effect of non-compliance of prophylaxis on surgical site infection. RESULTS: The study included a total of 930 patients. Antibiotic prophylaxis was indicated in all patients, and administered in 71.3% of cases, with an overall protocol compliance of 86.1%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 4.6%. No relationship was found between inadequate prophylaxis compliance and infection (relative risk=0.5; 95% CI: 0.1-1.9) (P>.05). CONCLUSIONS: Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate.

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis.

BACKGROUND: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. METHODS: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. RESULTS: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis

Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found (AU)

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