Single-institutional experience with the surgical infection prevention project in intra-abdominal surgery.
BACKGROUND
The incidence of surgical site infection (SSI) is becoming a key component of standard measures of quality of performance. We hypothesized that institutional implementation of a protocol targeting known risk factors would reduce the incidence of SSI associated with intra-abdominal surgery.


METHODS
Beginning in June 2004, a quality control initiative was implemented to prevent SSI in patients undergoing intra-abdominal surgical procedures at an academic medical center. This protocol included administration of the proper prophylactic antibiotic 0-60 minutes before incision, continued antibiotic administration for <or=24 hours, and maintenance of intraoperative normothermia (>or=36 degrees C), along with good glycemic control (goal<200 mg/dL 48 h postoperatively) in diabetic patients. Baseline data collected during the initial four months of protocol development (379 patients) were compared with data collected during the last four months of the 11-month study period (390 patients).


RESULTS
Compliance with antibiotic selection increased from 89 percent to 97 percent (p <or= 0.05). Compliance with timeliness of administration improved from 89 percent to 97 percent (p <or= 0.05), whereas cessation of perioperative antibiotics within 24 hours remained constant at 93 and 92 percent, respectively. The incidence of hypothermia fell from 15 percent to 10 percent (p = 0.27). The 30-day incidence of SSI improved from 9.2 percent to 5.6 percent (p = 0.07).


CONCLUSIONS
The implementation of a prevention protocol resulted in a substantial trend toward a reduction in the incidence of SSI. These data support the use of protocol implementation as a cost-effective method of reducing perioperative infectious morbidity associated with intra-abdominal surgery.
Hedrick
Traci L
TL
Surgical Infectious Disease Laboratory, University of Virginia Health System, Charlottesville, Virginia 22908, USA. th8q@virginia.edu
Turrentine
Florence E
FE
Smith
Robert L
RL
McElearney
Shannon T
ST
Evans
Heather L
HL
Pruett
Timothy L
TL
Sawyer
Robert G
RG
D000046:Academic Medical Centers; D019072:Antibiotic Prophylaxis / Q000379:methods; D003428:Cross Infection / Q000517:prevention & control*; D003920:Diabetes Mellitus; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007035:Hypothermia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*