Leveraging a Comprehensive Program to Implement a Colorectal Surgical Site Infection Reduction Bundle in a Statewide Quality Improvement Collaborative
- 1 October 2019
- journal article
- conference paper
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 270 (4), 701-711
- https://doi.org/10.1097/sla.0000000000003524
Abstract
Objectives: Our objective was to examine the implementation and associated clinical outcomes of a comprehensive surgical site infection (SSI) reduction bundle in a large statewide surgical quality improvement collaborative leveraging a multifaceted implementation strategy. Summary Background Data: Bundled perioperative interventions reduce colorectal SSI rates when enacted at individual hospitals, but the ability to implement comprehensive SSI bundles and to examine the resultant clinical effectiveness within a larger, diverse population of hospitals is unknown. Methods: A multifaceted SSI reduction bundle was developed and implemented in a large statewide surgical quality improvement collaborative through a novel implementation program consisting of guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence and ACS NSQIP outcomes were examined preimplementation versus postimplementation. Results: Among 32 hospitals, there was a 2.5-fold relative increase in the proportion of patients completing at least 75% of bundle elements (preimplementation = 19.5% vs. postimplementation = 49.8%, P = 0.001). Largest adherence gains were seen in wound closure re-gowning/re-gloving (24.0% vs. 62.0%, P < 0.001), use of clean closing instruments (32.1% vs. 66.2%, P = 0.003), and preoperative chlorhexidine bathing (46.1% vs. 77.6%, P < 0.001). Multivariable analyses showed a trend toward lower risk of superficial incisional SSI in the postimplementation period compared to baseline (OR 0.70, 95% CI 0.49–10.2, P = 0.06). As the adherence in the number of bundle elements increased, there was a significant decrease in superficial SSI rates (lowest adherence quintile, 4.6% vs. highest, 1.5%, P < 0.001). Conclusions: A comprehensive multifaceted SSI reduction bundle can be successfully implemented throughout a large quality improvement learning collaborative when coordinated quality improvement activities are leveraged, resulting in a 30% decline in SSI rates. Lower superficial SSI rates are associated with the number of adherent bundle elements a patient receives, rendering considerable benefits to institutions capable of implementing more components of the bundle.Keywords
This publication has 37 references indexed in Scilit:
- Surgical Site Infection after Colon Surgery: National Healthcare Safety Network Risk Factors and Modeled Rates Compared with Published Risk Factors and RatesJournal of the American College of Surgeons, 2012
- Chasing ZeroAnnals of Surgery, 2011
- A bundle of care to reduce colorectal surgical infections: an Australian experienceJournal of Hospital Infection, 2011
- The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvementBMJ Quality & Safety, 2011
- The Surgical Care Improvement Project and Prevention of Post-Operative Infection, Including Surgical Site InfectionSurgical Infections, 2011
- Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysisThe Lancet, 2011
- Surgical site infection: Incidence and impact on hospital utilization and treatment costsAmerican Journal of Infection Control, 2009
- Association of Timely Administration of Prophylactic Antibiotics for Major Surgical Procedures and Surgical Site InfectionJournal of the American College of Surgeons, 2008
- Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital DischargeEmerging Infectious Diseases, 2003
- Morbidity and mortality associated withsurgical site infections: results from the 1997–1999 INCISO surveillanceJournal of Hospital Infection, 2001