title: Evaluation of the Bundle "Zero Surgical Site Infection" to Prevent Surgical Site Infection in Vascular Surgery.
abstract: BACKGROUND
  To compare the incidence of surgical site infections (SSIs) before and after the implementation of a bundle of care called "Zero Surgical Site Infection." Secondary goals included estimating measures of association and their potential impact, determining care management indicators in vascular surgery, and evaluating the level of compliance with the bundle.
  
  
  METHODS
  This is a prospective observational study with a historic control group. The bundle included (1) removal of body hair with clippers; (2) preoperative showering with chlorhexidine soap; (3) preparation of the surgical field with alcoholic chlorhexidine 2%; (4) adequacy of antimicrobial prophylaxis; (5) intraoperative and (6) postoperative glycemic and central temperature control. Student's t-test and chi-squared test were performed. Relative risk, attributable risk, number needed to treat, and preventable fraction were used as association and impact measures.
  
  
  RESULTS
  In total, 192 patients were included. The overall incidence of SSI was 8.85%; the preventive fraction was 59.1%. The rate of incidence of SSI for clean surgery was reduced from 4.9% to 0% (P = 0.127), whereas the average hospital stay decreased from 22.38 to 13.70 days (P = 0.002). Concerning contaminated surgery, significant differences were found in the rate of incidence of SSI (33.3% vs. 13.9%, P = 0.035). Compliance with the bundle of preoperative and intraoperative measures exceeded 95% and almost reached 50%, respectively. Compliance with the bundle of postoperative measures reached 25%.
  
  
  CONCLUSIONS
  This bundle has demonstrated to be effective in reducing the incidence of SSI in vascular surgery. The publication of these initial results should encourage the implementation of this bundle at national level.
authors.affiliation: Preventive Medicine and Public Health Service, University Hospital Central of Asturias, Oviedo, Asturias, Spain; Preventive Medicine and Public and Communitary Area, Medicine Department, Faculty of Medicine, Oviedo University, Oviedo, Asturias, Spain. Electronic address: mariafdezprada@gmail.com.
authors.forename: María
authors.initials: M
authors.lastname: Fernández-Prada
authors.affiliation: Preventive Medicine and Public Health Service, University Hospital Central of Asturias, Oviedo, Asturias, Spain; Preventive Medicine and Public and Communitary Area, Medicine Department, Faculty of Medicine, Oviedo University, Oviedo, Asturias, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez-Ortega
authors.affiliation: Angiology and Vascular Surgery Service, University Hospital Central of Asturias, Oviedo, Asturias, Spain.
authors.forename: Livia
authors.initials: L
authors.lastname: Revuelta-Mariño
authors.affiliation: Angiology and Vascular Surgery Service, University Hospital Central of Asturias, Oviedo, Asturias, Spain.
authors.forename: Ángeles
authors.initials: Á
authors.lastname: Menéndez-Herrero
authors.affiliation: Preventive Medicine and Public Health Service, University Hospital of Elche, Alicante, Comunidad Valenciana, Spain; Spanish coordinator of Zero Surgical Site Infection Project, Spanish Society of Preventive Medicine, Public Health and Hygiene (SEMPSPH), University Hospital of Elche, Alicante, Comunidad Valenciana, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Navarro-Gracia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D064872:Patient Care Bundles; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*