A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery

Carolina Martinez, Pamela Omesiete, Viraj Pandit, Eli Thompson, Meleesa Nocera, Taylor Riall, Marlon Guerrero, Valentine Nfonsam

Research output: Contribution to journalArticle

Abstract

Background: Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery. Methods: We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate. Results: A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate. Conclusions: Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes.

Original languageEnglish (US)
Pages (from-to)100-105
Number of pages6
JournalJournal of Surgical Research
Volume246
DOIs
StatePublished - Feb 2020

Fingerprint

Surgical Wound Infection
Colon
Length of Stay
Comorbidity
Odds Ratio
Povidone-Iodine
Centers for Medicare and Medicaid Services (U.S.)
Patient Readmission
Propensity Score
Chlorhexidine
Anesthesiology
Bandages
Silver

Keywords

  • Colon surgery
  • Protocol
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery

Cite this

A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery. / Martinez, Carolina; Omesiete, Pamela; Pandit, Viraj; Thompson, Eli; Nocera, Meleesa; Riall, Taylor; Guerrero, Marlon; Nfonsam, Valentine.

In: Journal of Surgical Research, Vol. 246, 02.2020, p. 100-105.

Research output: Contribution to journalArticle

Martinez C, Omesiete P, Pandit V, Thompson E, Nocera M, Riall T et al. A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery. Journal of Surgical Research. 2020 Feb;246:100-105. https://doi.org/10.1016/j.jss.2019.08.018
Martinez, Carolina ; Omesiete, Pamela ; Pandit, Viraj ; Thompson, Eli ; Nocera, Meleesa ; Riall, Taylor ; Guerrero, Marlon ; Nfonsam, Valentine. / A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery. In: Journal of Surgical Research. 2020 ; Vol. 246. pp. 100-105.
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AU - Martinez, Carolina

AU - Omesiete, Pamela

AU - Pandit, Viraj

AU - Thompson, Eli

AU - Nocera, Meleesa

AU - Riall, Taylor

AU - Guerrero, Marlon

AU - Nfonsam, Valentine

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N2 - Background: Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery. Methods: We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate. Results: A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate. Conclusions: Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes.

AB - Background: Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery. Methods: We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate. Results: A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate. Conclusions: Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes.

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