Duke University Medical Center

Durham, North Carolina

Citation

Keenan JE, Speicher PJ, Thacker JKM, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: An effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149(10):1045-1052.

Results

Pre-Bundle Post-Bundle
Superficial SSI Rate: 19.3% Superficial SSI Rate: 5.7%
With Superficial SSI Without Superficial SSI
Variable Direct Costs: $13,253 Variable Direct Costs: $9,779
Length of Stay: 7.9 days Length of Stay: 4.6 days

SSI Prevention Bundle for Colorectal Surgery

Preoperative
Patient Education

Educate patients and provide reinforcement of SSI preventative measures and objectives

Chlorhexidine Shower

Provide patients materials and instructions to undergo a full-body chlorhexidine gluconate shower the night before surgery

Mechanical Bowel Prep with Oral Antibiotics

Polyethylene glycol 3350 bowel preparation with oral antibiotics (neomycin sulfate and erythromycin)

Antibiotic Prophylaxis

Patients without an allergy receive a single 1g dose of ertapenem sodium within 1 hour of incision

Patients with allergy receive ciprofloxacin hydrochloride and metronidazole

Skin Prep

2% chlorhexidine gluconate-70% isopropyl alcohol solution

Operative
Patient Education

Educate patients and provide reinforcement of SSI preventative measures and objectives

Fascial Wound Protector

Use wound protector for open incisions

Limited OR Traffic

Limit operating room traffic to essential personnel

Temperature Control

Anesthesiologist pay close attention to maintenance of normothermia

Glycemic Control

Anesthesiologist pay close attention to maintenance of euglycemia

Gown & Glove Change

At the time of wound closure, surgeons and scrub staff undergo a gown and glove change

Dedicated Wound Closure Tray

At the time of wound closure, use dedicated wound closure tray to close the fascia and skin

Sterile Dressing

Following wound closure, place a sterile occlusive dressing over the incisions

Postoperative
Patient Education

Educate patients and provide reinforcement of SSI preventative measures and objectives

On discharge, provide patient with materials and instructions to continue the chlorhexidine washes for 1 week following surgery

Timely Dressing Removal

Remove dressing within 48 hours from the time of surgery

Daily Chlorhexidine Washings

Wash wound daily with chlorhexidine

Temperature Control

Maintain normothermia in the early postoperative period

Glycemic Control

Pay close attention to maintenance of euglycemia