Multidisciplinary, perioperative care bundle decreases surgical site infection in patients undergoing synchronous colorectal/liver resection

Showering preoperatively with chlorhexidine gluconate is an issue that continues to promote debate; however, many studies demonstrate evidence of surgical site infection risk reduction. Methodological issues have been present in many of the studies used to compile guidelines and there has been a lack of standardisation of processes for application of the active agents in papers pre-2009. This review and commentary paper highlights the potential for enhancing compliance with this low-risk and low-cost intervention and provides some guidance for enhancing implementation of preoperative showering with both chlorhexidine in solution and impregnated wipes.

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Predictors of surgical site infection after liver resection: a multicentre analysis using National Surgical Quality Improvement Program data

HPB ◽

10.1111/j.1477-2574.2011.00417.x ◽

2012 ◽

Vol 14 (2) ◽

pp. 136-141 ◽

Cited By ~ 69

Author(s):

Almudena Moreno Elola-Olaso ◽

Daniel L. Davenport ◽

Jonathan C. Hundley ◽

Michael F. Daily ◽

Roberto Gedaly

Keyword(s):

Quality Improvement ◽

Liver Resection ◽

Surgical Site Infection ◽

Quality Improvement Program ◽

Site Infection ◽

Improvement Program ◽

Surgical Quality ◽

Program Data

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Surgical Site Infection after Malignant Brain Tumor Resection: A Multicenter Study for Induction of a Basic Care Bundle

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2017-0034 ◽

2017 ◽

Vol 57 (10) ◽

pp. 542-547 ◽

Cited By ~ 8

Author(s):

Takeo UZUKA ◽

Hideaki TAKAHASHI ◽

Yoko NAKASU ◽

Takeshi OKUDA ◽

Koichi MITSUYA ◽

...

Keyword(s):

Brain Tumor ◽

Surgical Site Infection ◽

Multicenter Study ◽

Tumor Resection ◽

Malignant Brain Tumor ◽

Care Bundle ◽

Site Infection ◽

Basic Care ◽

Brain Tumor Resection

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SP3.1.3 Use of a Care Bundle to reduce Surgical Site Infection after Emergency Laparotomy

British Journal of Surgery ◽

10.1093/bjs/znab361.056 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

C Swain ◽

J Rogers ◽

D Gane ◽

M Quinn ◽

J Hopkins ◽

...

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Care Bundle ◽

Emergency Laparotomy ◽

Site Infection ◽

Skin Preparation ◽

Elective Colorectal Surgery ◽

Changing Practice ◽

Patient Reported ◽

Surgical Teams

Abstract Aim Surgical Site Infection (SSI) is common after abdominal surgery. A care bundle was introduced to sustainably reduce SSI after elective colorectal surgery. This study aimed to implement an expanded care bundle after emergency laparotomy. Methods Quality improvement methodology was used. SSI was measured by direct assessment of the wound in patients in hospital at 30 days. For discharged patients, the PHE SSI surveillance questionnaire was used to measure patient-reported SSI 30 days post-operatively. The care bundle included: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; second dose of antibiotics >4 hours, betadine to the wound and glove change before closure. Bundle compliance was measured and fed back to surgical teams. Results Baseline SSI was 13.5% (178 patients) which reduced to 8.5% (118 patients) following bundle introduction. Response rate was 60%. Compliance with antibacterial sutures was measured for patients whose wounds were closed; 10% received negative pressure dressings. Mortality within 30 days was 9%. Length of stay reduced from mean 22.6 to 12.45, median 13.5 to 9 days. Conclusion The care bundle reduced SSI after emergency laparotomy. Measuring SSI is more difficult after emergency surgery due to higher death rate, longer length of stay and use of laparostomy. Other challenges include difficulty using wound protectors for some procedures e.g. adhesiolysis and changing practice from use of skin clips.

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Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032010000200012 ◽

2010 ◽

Vol 47 (2) ◽

pp. 178-183 ◽

Cited By ~ 17

Author(s):

José Eduardo de Aguilar-Nascimento ◽

Alberto Bicudo Salomão ◽

Cervantes Caporossi ◽

Breno Nadaf Diniz

Keyword(s):

Elderly Patients ◽

Surgical Site Infection ◽

Hospital Stay ◽

Perioperative Care ◽

Length Of Hospital Stay ◽

Intravenous Fluids ◽

Site Infection ◽

Preoperative Fasting ◽

Historical Cohort ◽

Abdominal Operations

CONTEXT: Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. OBJECTIVE: To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. METHODS: Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. RESULTS: The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). CONCLUSION: The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

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