Browsing by Subject "Surgical site infection"

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    Operating Room Improvements Based on Environmental Quality Index Risk Prediction can help Reduce Surgical Site Infections
    (European Society of Medicine, 2022) Wagner, Jennifer; Gormley, Thomas; Markel, Troy A.; Greeley, Damon; Surgery, School of Medicine
    Importance: The role of the operating room (OR) airborne environment in the incidence of surgical site infections (SSI) has ranked behind patient and perioperative team-related factors associated with risk for SSI. Emerging evidence demonstrates that the design and performance of the OR environment impacts the airborne microbiome both within the sterile field and at tables where instruments and implants are exposed. However, the correlation between OR air quality and the risk of SSI continues to be challenged. Objective: To determine if improving the asepsis of the airborne environment in ORs contributes to reduced SSI rates. Design: The performance of air delivery systems in fourteen operating rooms was evaluated using the Environmental Quality Indicator (EQI) risk picture method to identify potential improvements to airflow management that reduce airborne contamination and operating costs. SSI rates for colon and abdominal hysterectomy procedures were tracked in these ORs for 39 months before and after improvements were implemented. SSI rates were also tracked for the same time frame for six control ORs in which no improvements were made. Airborne microbial data was collected. Setting: Twenty ORs in an academic medical center, Midwest USA. A convenience sample of all surgical patients, de-identified, was used in the twenty ORs studied. Results: SSI rate was reduced from 8.4% to 5.7% (p=.0039) in ORs in which improvements were implemented. Reduction of SSI rate in control ORs was not significant (p=.76). Fewer airborne microbes were detected in areas of OR with improvements (p<.0001). Conclusion: Areas for environmental quality improvement in ORs was identified and mapped by relative risk of contamination. Implementation of these improvements resulted in decreased microbial contamination and contributed to significant reduction in surgical site infection.
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    Unbundling Bundles: Evaluating the Association of Individual Colorectal Surgical Site Infection Reduction Bundle Elements on Infection Rates in a Statewide Collaborative
    (Wolters Kluwer, 2022) Schlick, Cary Jo R.; Huang, Reiping; Brajcich, Brian C.; Halverson, Amy L.; Yang, Anthony D.; Kreutzer, Lindsey; Bilimoria, Karl Y.; McGee, Michael F.; Illinois Surgical Quality Improvement Collaborative; Surgery, School of Medicine
    BACKGROUND: Surgical site infection reduction bundles are effective but can be complex and resource intensive. Understanding which bundle elements are associated with reduced surgical site infections may guide concise bundle implementation. OBJECTIVE: To evaluate the association of individual surgical site infection reduction bundle elements with infection rates. DESIGN: Post-hoc analysis of a prospective cohort study SETTING: Illinois Surgical Quality Improvement Collaborative hospitals PATIENTS: Elective colorectal resections at participating hospitals from 2016–2017 INTERVENTIONS: 16-element colorectal surgical site infection reduction bundle MAIN OUTCOME MEASURES: Surgical site infection rates were compared among patients by adherence with each bundle element using Chi-squared tests and multivariable logistic regression. Principal component analysis identified composites of correlated bundle elements. Coincidence analysis identified combinations of bundle elements or principal component composites associated with the absence of surgical site infection. RESULTS: Among 2,722 patients, 192 (7.1%) developed a surgical site infection. Infections were less likely when oral antibiotics (OR 0.63 [95% CI 0.41–0.97]), wound protectors (OR 0.55 [95% CI 0.37–0.81]), and occlusive dressings (OR 0.71 [95% CI 0.51–1.00]) were used. Bundle elements were reduced into 5 principal component composites. Adherence with the combination of (1) oral antibiotics, (2) wound protector, or (3) redosing intravenous antibiotic prophylaxis plus chlorhexidine-alcohol intraoperative skin preparation were associated with the absence of infection (consistency=0.94, coverage=0.96). Four of the five principal component composites in various combinations were associated with the absence of surgical site infection, while the composite consisting of occlusive dressing placement, postoperative dressing removal, and daily postoperative chlorhexidine incisional cleansing had no association with the outcome. LIMITATIONS: The inclusion of hospitals engaged in quality improvement initiatives may limit the generalizability of these data. CONCLUSION: Bundle elements had varying association with infection reduction. Implementation of colorectal surgical site infection reduction bundles should focus on the specific elements associated with low surgical site infections. See Video Abstract at http://links.lww.com/DCR/Bxxx.