title: Reducing colorectal surgical site infections: a novel, resident-driven, quality initiative.
abstract: BACKGROUND
  Surgical site infections (SSIs) cause significant patient morbidity and increase costs. This work prospectively examines our institutional effort to reduce SSIs through a resident-driven quality initiative.
  
  
  METHODS
  A general surgery resident-championed, evidenced-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship. National Surgical Quality Improvement Program definitions for SSIs were used. Data were collected prospectively and bundle compliance was monitored using a checklist. The primary outcome compared SSIs before and after implementation.
  
  
  RESULTS
  In the 2 years preceding standardization, 489 colorectal surgery cases were performed. SSIs occurred in 68 patients (13.9% SSI rate). Following implementation of the bundle, 212 cases were performed with 10 SSIs (4.7% SSI rate, P < .01). Multivariate logistic regression analysis found a decrease in superficial and overall SSIs (odds ratio .17, 95% confidence interval .05 to .59; odds ratio .31, 95% confidence interval .14 to .68).
  
  
  CONCLUSIONS
  These data demonstrate that resident-driven initiatives to improve quality of care can be a swift and effective way to enact change. We observed significantly decreased SSIs with a renewed focus on evidence-based, standardized patient care.
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Daniel Brock
authors.initials: DB
authors.lastname: Hewitt
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Sami S
authors.initials: SS
authors.lastname: Tannouri
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Burkhart
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Randi
authors.initials: R
authors.lastname: Altmark
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Goldstein
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Isenberg
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Phillips
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, 834 Walnut St., Suite 650, Philadelphia, PA 19107, USA. Electronic address: Scott.Cowan@jefferson.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Cowan
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Colorectal; Outcomes; Quality; Resident; Surgical site infection