title: Evaluation of a preventive surgical site infection bundle in colorectal surgery.
abstract: OBJECTIVE
  To assess the effectiveness of a protocol for prevention of surgical site infection (SSI) in colorectal surgery.
  
  
  METHODS
  Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital: A historical cohort (2008-2011) and a prospective one (after the implementation of the program in 2012). The main measures established were: Adequacy of preoperative antimicrobial prophylaxis, maintaining patient normothermia and appropriate glove change during the intervention. Comparability of the two cohorts was determined by a bivariate analysis of age, sex, NNIS index, ASA index, surgical time, perioperative transfusion, diagnosis, diabetes and renal failure.
  
  
  RESULTS
  We assessed 342 patients (256 underwent colon surgery and 86 rectal surgery), divided into 2 cohorts: prior period (218), and post-implementation period (124). The cumulative incidence of SSI in the first cohort was 27.5% (95% CI, 21.6- 33.4), and in the post-intervention cohort 16.9% (95% CI, 10.3-23.5, P=.03). Postoperative mortality was 9.2% (95% CI, 5.4-13) in the first cohort and 3.2% (95% CI, 0.1-6.3) in the post-intervention cohort (P=.04). The inadequacy of prophylaxis decreased from 37.4% (95% CI, 30.4-44.6) to 18.9% (95% CI, 11.9- 26.1) (P=.001).
  
  
  CONCLUSIONS
  A significant decrease in the frequency of SSI, post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery.
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, España. Electronic address: vperezb@salud.madrid.org.
authors.forename: Verónica
authors.initials: V
authors.lastname: Pérez-Blanco
authors.affiliation: Servicio de Cirugía General, Hospital Universitario La Paz, Madrid, España.
authors.forename: Damián
authors.initials: D
authors.lastname: García-Olmo
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda-Garrido
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, España.
authors.forename: María Cruz
authors.initials: MC
authors.lastname: Nájera-Santos
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario La Paz, Madrid, España.
authors.forename: Juan
authors.initials: J
authors.lastname: García-Caballero
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D064872:Patient Care Bundles; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Cirugía colorrectal; Colorectal surgery; Infección de localización quirúrgica; Mortalidad postoperatoria; Postoperative mortality; Surgical site infection