title: Reduction of surgical site infections after implementation of a bundle of care.
abstract: BACKGROUND
  Surgical Site Infections (SSI) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality.
  
  
  OBJECTIVE
  Implementing a bundle of care and measuring the effects on the SSI rate.
  
  
  METHODS
  Prospective quasi experimental cohort study.
  
  
  METHODS
  A prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures.
  
  
  RESULTS
  Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5%) occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days) and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76-4.18). Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008.
  
  
  CONCLUSIONS
  The implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety.
authors.affiliation: Department of surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Rogier M P H
authors.initials: RM
authors.lastname: Crolla
authors.forename: Lijckle
authors.initials: L
authors.lastname: van der Laan
authors.forename: Eelco J
authors.initials: EJ
authors.lastname: Veen
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Hendriks
authors.forename: Caroline
authors.initials: C
authors.lastname: van Schendel
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents