title: Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program--driven multidisciplinary single-institution experience.
abstract: BACKGROUND
  Surgical site infections (SSI) are a major cause of morbidity in surgical patients and they increase health care costs considerably. Colorectal surgery is consistently associated with high SSI rates. No single intervention has demonstrated efficacy in reducing colorectal SSIs. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a nationally validated system that uses clinically abstracted data on surgical patients and their outcomes to assist participating institutions drive quality improvement.
  
  
  METHODS
  A multidisciplinary team was assembled to develop a colorectal SSI-reduction bundle at an academic tertiary care medical center. The ACS NSQIP data were used to identify patterns of SSIs during a 2-year period. Multiple interventions across the entire surgical episode of care were developed and implemented in January 2011. Monthly ACS NSQIP data were used to track progress.
  
  
  RESULTS
  Our ACS NSQIP overall colorectal SSI rate for 2009 and 2010 was 9.8%. One year after implementation of the SSI reduction bundle, we demonstrated a significant decline (p < 0.05) in both overall and superficial SSIs, to 4.0% and 1.5%, respectively. Organ space infections declined to 2.6%, which was not a significant change (p = 0.10). During the entire analysis period (2009 to 2011), there was no change in our colorectal-specific Surgical Care Improvement Program performance.
  
  
  CONCLUSIONS
  Using our ACS NSQIP colorectal SSI outcomes, a multidisciplinary team designed a colorectal SSI reduction bundle that resulted in a substantial and sustained reduction in SSIs. Our study is not able to identify which specific elements contributed to the reduction.
authors.affiliation: Department of Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. cima.robert@mayo.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Cima
authors.forename: Eugene
authors.initials: E
authors.lastname: Dankbar
authors.forename: Jenna
authors.initials: J
authors.lastname: Lovely
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pendlimari
authors.forename: Kimberly
authors.initials: K
authors.lastname: Aronhalt
authors.forename: Sharon
authors.initials: S
authors.lastname: Nehring
authors.forename: Roxanne
authors.initials: R
authors.lastname: Hyke
authors.forename: Diane
authors.initials: D
authors.lastname: Tyndale
authors.forename: James
authors.initials: J
authors.lastname: Rogers
authors.forename: Lynn
authors.initials: L
authors.lastname: Quast
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D062606:Tertiary Care Centers