title: Outcome of a strategy to reduce surgical site infection in a tertiary-care hospital.
abstract: BACKGROUND
  Surgical site infection (SSI) is a preventable complication. Achieving a zero SSI rate for all clean operations should be the goal of all surgeons.
  
  
  OBJECTIVE
  We aimed to reduce our SSI rate by 50% for patients undergoing elective gastrointestinal and hernia operations.
  
  
  METHODS
  The study was conducted in a tertiary-care hospital department of surgery from January 2006 to December 2007 for all clean and clean-contaminated elective gastrointestinal and hernia operations. Four interventions targeted at reducing SSI were implemented in January 2006: Use of clippers instead of shavers for surgical site hair removal; standardized prophylactic antibiotic regimen and antibiotic administration within 30 min before incision; standardized glucose monitoring for diabetics; and maintenance of postoperative normothermia. Prospective data were collected and compared with historical data from January to December 2005.
  
  
  RESULTS
  A total of 2,408 patients underwent elective gastrointestinal and hernia operations from January 2006 to December 2007. After implementation, we were able to achieve 91%, 87%, 89%, and 76% overall compliance with the respective interventions, but postoperative normothermia was achieved in only 44% of our patients. With the bundle of interventions, our overall SSI rate was reduced from 3.1% to 0.5% (p < 0.001), an 84% reduction within two years. The incidence of SSI was 1.7% in colorectal operations, 1.2% in upper gastrointestinal operations, 0.3% in hepatopancreaticobiliary operations, and zero in inguinal and ventral hernia operations. The estimated cost saving for both the patients and the hospital was S$208,562 (US$147,967).
  
  
  CONCLUSIONS
  Surgical site infections could be reduced with the bundle of interventions. With these encouraging results, the good practices should be sustained and promulgated. Such a SSI prevention program must be embedded in the work processes for all surgical disciplines.
authors.affiliation: Department of Surgery, Digestive Diseases Centre, Tan Tock Seng Hospital, Singapore. Kui_Hin_Liau@ttsh.com.sg
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Khin-Thanda
authors.initials: KT
authors.lastname: Aung
authors.forename: Nelson
authors.initials: N
authors.lastname: Chua
authors.forename: Choon-Kiat
authors.initials: CK
authors.lastname: Ho
authors.forename: Chung-Yip
authors.initials: CY
authors.lastname: Chan
authors.forename: Alfred
authors.initials: A
authors.lastname: Kow
authors.forename: Arul
authors.initials: A
authors.lastname: Earnest
authors.forename: Sing-Joo
authors.initials: SJ
authors.lastname: Chia
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D005767:Gastrointestinal Diseases / Q000601:surgery; D006204:Hair Removal / Q000379:methods; D017048:Health Care Costs; D059685:Herniorrhaphy; D006761:Hospitals; D017053:Infection Control / Q000191:economics / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome