1. Evaluation of a bundle of care to reduce incisional surgical site infection after gastrointestinal surgery.
- Author
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Phelan, Liam, Dilworth, Mark P, Bhangu, Aneel, Limbrick, Jack W, King, Stratton, Bowley, Doug M, and Hardy, Katie
- Subjects
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EVALUATION of medical care , *ABDOMINAL surgery , *ATTITUDE (Psychology) , *CHI-squared test , *CLINICAL trials , *COMPARATIVE studies , *CONFIDENCE intervals , *HOSPITAL emergency services , *LONGITUDINAL method , *MEDICAL personnel , *MEDICAL protocols , *PATIENTS , *PUBLIC hospitals , *STATISTICS , *ELECTIVE surgery , *OPERATIVE surgery , *SURGICAL site infections , *TIME , *MULTIPLE regression analysis , *PRE-tests & post-tests , *PATIENT readmissions , *EVALUATION of human services programs , *DATA analysis software , *DESCRIPTIVE statistics , *ANTIBIOTIC prophylaxis , *PERIOPERATIVE care , *ODDS ratio , *EVALUATION ,DIGESTIVE organ surgery - Abstract
Background: Surgical site infection (SSI) is associated with morbidity, mortality and increased care costs; many SSIs are considered preventable. The aim of the present study was to test implementation of a pragmatic, evidence-based bundle designed to reduce incisional SSI after emergency laparotomy and elective major lower gastrointestinal surgery. Method: This was a prospective before-and-after study. Data were collected before the intervention and for two separate subsequent time periods. An evidence-based bundle of care (BOC) was implemented; the primary outcome measure was incisional SSI at 30 days. The secondary outcome measure was 30-day unplanned readmissions. The initial post-intervention group, Group 2, assessed a variable number of potential impacting factors; however, due to funding and staffing levels the second post-bundle group, Group 3, focused on the core aspects of the BOC and rates of incisional SSI and readmission. Results: In total, 99 patients were included in the 'before' group; and 71 in Group 2 and 92 in Group 3, the post-intervention groups. The incisional SSI rate was 29.3% (29/99) before and 28.2% (20/71) in Group 2 (P =0.873) and 21.7% (20/92) in Group 3 (P =0.234) after the intervention. After adjustment for confounders, the care bundle was associated with a non-significant reduction in SSI (Group 2: odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.45–1.93, P =0.0843). However, it was associated with significantly reduced readmissions 18.1% (18/99) before versus 5.6% (4/71) in Group 2 (OR = 0.236, 95% CI = 0.077–0.72, P =0.012) and 8.7% (8/92) in Group 3 (OR = 0.38, 95% CI = 0.16–0.9, P =0.029). Comparing the pre-bundle group to the post-bundle groups, there was an overall significant reduction in readmissions (P =0.003). This implies a number needed to treat of 8–11 patients to prevent one readmission. Adherence to antibiotic prophylaxis with the Trust guidelines increased from 91% to 99% (1 vs. 2, P =0.047). Conclusion: Introduction of the bundle was associated with a reduction in the observed rate of incisional SSI from 29.3% to 21.7%; significantly fewer patients required unplanned readmission. Use of the bundle was associated with significantly improved compliance with appropriate antimicrobial prophylaxis. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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