Cleveland Clinic

Cleveland, Ohio

Citation

Bundled care program cuts colorectal surgical site infection rates in half. Cleveland Clinic Consult QD. http://consultqd.clevelandclinic.org/2015/09/bundled-care-program-cuts-colorectal-surgical-site-infection-rates-in-half. Published September 24, 2015. Accessed October 14, 2015.

Gorgun E. SSI Bundles skin prep, oral antibx/bowel prep wound protector. Talk presented at: Reducing SSI: Take action with evidence; May 2, 2014; Baltimore, MD.

Results

Pre-Bundle Post-Bundle
N/A Observed infection rates were reduced by nearly one half when comparing the one-year outcomes of the prevention bundle to the pre-bundle period

SSI Prevention Bundle for Colorectal Surgery

Preoperative
Mechanical bowel prep plus oral antibiotics

Orally at 1hr and 2hrs after completion of Neomycin and Metronidazole MBP

Patient preoperative shower at home with CHG

If patient non-compliant, pre-operative washing in the preop area by nurses w/CHG wash cloth

Perioperative
Surgical prophylaxis w Ceftriaxone 2g+ Metronidazole 500mg

If PCN allergy: Cipro+Flagyl or aztreonam+clindamycin

Standard, sterile skin prep (alcohol free-CHG) by O.R. nurse Wound edge protection for all class 2, 3 and 4 wounds
Glove change after each intraoperative digital rectal examination Sleeve placement and glove change after anastomosis Glove change for wound closure
Suction tip change and wound washout with saline Separate closure instruments Sterile dressing application by scrub nurse
Postoperative
Dressing removal after 48 hours Wound check and SSI assessment and documentation