title: Sustained reduction in surgical site infection after abdominal hysterectomy.
abstract: BACKGROUND
  During a period of five years, the rate of surgical site infection (SSI) after abdominal hysterectomy at our institution was >10%. With the implementation of a multifaceted intervention designed to reduce this, the rate of SSI fell to <2% in the post-intervention period. The pre- and post-intervention periods were compared to determine which of the interventions in the multifaceted array of interventions was most valuable in decreasing SSI.
  
  
  METHODS
  A retrospective chart review was done to identify: (1) Parameters associated with SSI, and (2) parameters that differed in the pre- and post-intervention periods. The intervention included providing departmental SSI rates to the gynecology faculty, re-educating operating room (OR) staff personnel about appropriate perioperative antibiotic choice and timing, and changing the preferred sterile preparation for abdominal surgery from 10% povidone-iodine (PI) to 4% chlorhexidine gluconate (CHG). The preliminary results of our review also led to the suggestion that surgeons use blood products sparingly, although an absolute threshold for transfusion was not specified.
  
  
  RESULTS
  Twenty-one of 192 patients (10.7%) developed an SSI in the pre-intervention period, whereas 1 of 84 patients (1.2%) developed an SSI in the post-intervention period (p=0.006). Surgical site infection was associated with obesity (a body mass index [BMI] ≥30) (11.5% vs. 4.8%, p=0.04), receipt of a blood transfusion (18.2% vs. 6.6%, p=0.03), and abdominal skin preparation with PI as opposed to CHG (10.1% vs. 2.0%, p=0.07). Chlorhexidine gluconate was used more commonly for abdominal skin preparation in the post- than in the pre-intervention period (6.6% pre-intervention vs. 50.7% post-intervention, p <0.0001).
  
  
  CONCLUSIONS
  A multifaceted intervention decreased dramatically the rate of SSI after abdominal hysterectomy at our institution. No single component of the intervention could be identified as most responsible for the improvement.
authors.affiliation: 1 Division of Infectious Diseases, Denver Health Medical Center and University of Colorado Denver , Denver, Colorado.
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.forename: Bryan
authors.initials: B
authors.lastname: Knepper
authors.forename: Cathy
authors.initials: C
authors.lastname: Vigil
authors.forename: Amber
authors.initials: A
authors.lastname: Miller
authors.forename: J Chris
authors.initials: JC
authors.lastname: Carey
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
mesh_terms: D000279:Administration, Cutaneous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007430:Intraoperative Care / Q000379:methods; D008505:Medical Staff, Hospital / Q000193:education; D009765:Obesity / Q000150:complications; D011206:Povidone-Iodine / Q000008:administration & dosage; D013530:Surgical Wound Infection / Q000517:prevention & control*; D065227:Transfusion Reaction
chemical_list: D000900:Anti-Bacterial Agents; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine