title: Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.
abstract: BACKGROUND
  Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery.
  
  
  OBJECTIVE
  To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates.
  
  
  METHODS
  Prospective, quasi-experimental, cohort study.
  
  
  METHODS
  A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback.
  
  
  RESULTS
  Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009.
  
  
  CONCLUSIONS
  The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing vascular surgery.
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands. jvanderslegt@gmail.com
authors: Jasper
authors: J
authors: van der Slegt
authors: Lijckle
authors: L
authors: van der Laan
authors: Eelco J
authors: EJ
authors: Veen
authors: Yvonne
authors: Y
authors: Hendriks
authors: Jannie
authors: J
authors: Romme
authors: Jan
authors: J
authors: Kluytmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
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