Outcome of a strategy to reduce surgical site infection in a tertiary-care hospital.
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.
Liau
Kui-Hin
KH
Department of Surgery, Digestive Diseases Centre, Tan Tock Seng Hospital, Singapore. Kui_Hin_Liau@ttsh.com.sg
Aung
Khin-Thanda
KT
Chua
Nelson
N
Ho
Choon-Kiat
CK
Chan
Chung-Yip
CY
Kow
Alfred
A
Earnest
Arul
A
Chia
Sing-Joo
SJ
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