title: The "bundle" approach to reduce the surgical site infection rate.
abstract: OBJECTIVE
  In Italy, since 2008, the surveillance of surgical site infections (SSIs) has been conducted following ECDC recommendations, according to the protocol of the National System of Surveillance of Surgical Site Infections. In 2009, in Piedmont region, where the study was conducted, it was introduced a survey of a "bundle" for every patient under SSIs surveillance. The bundle includes 5 items: infection risk index calculation, preoperative shower, trichotomy, antibiotic prophylaxis, and body temperature control. The aim of this study is the evaluation of the incidence rate of the SSIs in relation to the implementation of the bundle from January 1st to December 31st, 2012.
  
  
  METHODS
  This study is an observational study (retrospective cohort). The regional surveillance system collected 3314 surgical operations during the year 2012 from 37 hospitals. The represented surgical categories were hip prosthetic surgery (HPRO: 1992 cases) and colon surgery (COLO: 1322 cases). The bundle was implemented in 1114 and 671 operations, respectively. Univariate and multivariate analysis were conducted stratifying the sample for hip surgery and colorectal surgery, with the purpose to identify an association between the implementation of the bundle and a decrease of the rate of SSIs.
  
  
  RESULTS
  From the analysis, the bundle resulted as a protective factor for the infection risk in colon surgery (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.38-0.78). The main risk factors were American Society of Anesthesiologists score ≥ 3 (OR, 1.57; 95% CI, 1.10-2.24) and contamination class ≥ 3 (OR, 2.02; 95% CI, 1.37-2.97). In the hip surgery, the application of the bundle was not statistically associated to a decrease of the risk of infection.
  
  
  CONCLUSIONS
  The use of surgical bundle seems to reduce significantly the SSIs rate in the colon surgery.
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bert
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giacomelli
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Amprino
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Pieve
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ceresetti
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Testa
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Zotti
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001494:Baths / Q000379:methods; D001831:Body Temperature; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D016017:Odds Ratio; D064872:Patient Care Bundles / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: SSI; bundle; colon surgery; hip prosthesis; incidence; infections; surgery; surgical site; surveillance