title: The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology.
abstract: BACKGROUND
  Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.
  
  
  METHODS
  Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014-30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015-15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle.
  
  
  RESULTS
  A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37-0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38-0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34-0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month.
  
  
  CONCLUSIONS
  This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jolyn S
authors: JS
authors: Taylor
authors: Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Claire A
authors: CA
authors: Marten
authors: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Mark F
authors: MF
authors: Munsell
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Charlotte C
authors: CC
authors: Sun
authors: Department of Perioperative Services, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Kimberly A
authors: KA
authors: Potts
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jennifer K
authors: JK
authors: Burzawa
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Alpa M
authors: AM
authors: Nick
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Larissa A
authors: LA
authors: Meyer
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Keith
authors: K
authors: Myers
authors: Department of Clinical Education, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Diane C
authors: DC
authors: Bodurka
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Thomas A
authors: TA
authors: Aloia
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Charles F
authors: CF
authors: Levenback
authors: Department of Management and Policy Sciences, The University of Texas School of Public Health, Houston, TX, USA.
authors: David R
authors: DR
authors: Lairson
authors: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. KSchmele@mdanderson.org.
authors: Kathleen M
authors: KM
authors: Schmeler
mesh_terms: D019072:Antibiotic Prophylaxis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D013781:Texas / Q000453:epidemiology