A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications

Guo, Xiaojia; Runge, M.; Miller, Dick R.; Aaby, David; Milad, Magdy P.

doi:10.1002/ijgo.13257

Cited by 12 publications

(12 citation statements)

References 27 publications

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“…At one academic medical center, the incidence of SSIs after hysterectomy decreased from 4.51% before implementation of a bundle to 1.87% after implementation ( P = .001) 26 . At another academic medical center, the SSI rate after hysterectomy dropped from 2.7% before bundle implementation to 0.4% after implementation (odds ratio = 7.41; 95% confidence interval, 1.67 to 32.75) 27 . At a third academic medical center, interdisciplinary team members recognized that the SIR associated with hysterectomies was 3.5.…”

Section: Literature Reviewmentioning

confidence: 99%

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Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal‐Approach Hysterectomy at a Midwestern Teaching Hospital

Balagna,

Boyd,

Arnold

et al. 2023

AORN Journal

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Accrediting organizations, third‐party payers, and patients review the surgical site infection (SSI) rates of health care organizations. Infection preventionists collaborate with perioperative personnel to decrease SSI rates; they also monitor and report SSI information to national organizations. The standard infection ratio is a comparison of the observed number of SSIs to the predicted number of SSIs based on national benchmark data. Leaders of a midwestern teaching hospital convened an interdisciplinary team (eg, surgeons, perioperative leaders, infection preventionists) to address a standard infection ratio after hysterectomies that was greater than 1.0. The team reviewed national guidelines and published articles on decreasing SSIs (including recommendations for vaginal preparation) before developing and implementing a hysterectomy‐specific bundle for SSI prevention. The rate of SSIs decreased 68% after the implementation of the bundle. Perioperative personnel at this facility continue to use the bundle and infection preventionists monitor and report compliance with the bundle's elements.

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Section: Literature Reviewmentioning

confidence: 99%

“…Results of several QI projects reflect improved SSI rates after implementing SSI‐prevention bundles 26‐29 . At one academic medical center, the incidence of SSIs after hysterectomy decreased from 4.51% before implementation of a bundle to 1.87% after implementation ( P = .001) 26 .…”

Section: Literature Reviewmentioning

confidence: 99%

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal‐Approach Hysterectomy at a Midwestern Teaching Hospital

Balagna,

Boyd,

Arnold

et al. 2023

AORN Journal

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“…Guo et al [16] (2020) found that 515 hysterectomies in the same period before bundle implementation representing a decrease in SSI rate from 2.7% to 0.4% (odds ratio, 7.41; 95% confidence interval, 1.67-32.75). The two SSIs in the post-bundle period occurred in open hysterectomies, whereas 8 (57.1%) SSIs in the pre-bundle period occurred in minimally invasive hysterectomies.…”

Section: Distribution Of Mean Age Bmi Operation Duration and Hospital...mentioning

confidence: 99%

Assessment of Bundle of Measures Perioperatively to Decrease the Incidence of Surgical Site Wound Infection in Patients Undergoing Abdominal Hysterectomies

Biswas

Ray

Kolay

et al. 2022

APJHS

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Background: Surgical site infections (SSIs) are the second most common reason for unplanned hospital readmissions after hysterectomy and result in increased morbidity and health care costs. The estimated rate of SSI after hysterectomy varies between 1% and 4%. The objective of the study is to investigate if a bundle of perioperative measures (as stated earlier) reduces down the incidence of post-operative surgical site wound infection after abdominal hysterectomy. Materials and Methods: The present prospective study was carried out on total 200 women who were undergo hysterectomy in the operation theater of Department of Obstetrics and Gynecology of IPGMER and SSKM Hospital due to gynecological conditions requiring hysterectomy. Four perioperative bundles of measures are considered – 1. chlorhexidine gluconate and Cetrimide solution (Savlon) wash of the operative field 1 h before the operation, 2. administration of single dose antibiotic (Inj. Ceftriaxone 1 g intravenous) 1 h or less before the incision, 3. vaginal wash with povidone-iodine, and 4. sterile dressing is to be maintained and removed postoperatively after 48 h. Result: We found that in case, 94 (94.0%) patients had Ceftriaxone and 6 (6.0%) patients had clindamycin and gentamicin. In control, 96 (96.0%) patients had ceftriaxone and 4 (4.0%) patients had clindamycin and gentamicin. Association of choice of antibiotic versus group was not statistically significant (P = 0.5164). In case, 6 (6.0%) patients had wound gaping. In control, 11 (11.0%) patients had wound gaping. Association of wound gaping versus group was statistically significant (P = 0.048). Conclusion: The present study found that hospital stay was more in control compared to case which was statistically significant. Fever was more in control compared to case which was statistically significant. In this study, local wound discharge was more in control compared to case which was statistically significant. It was found that wound gaping was more in control compared to case which was statistically significant.

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“…Gillispie-Bell (46) defines normothermia as a core temperature of at least 36˚C measured immediately on the post-anesthesia care unit. A gynaecology-specific 'bundle' has been assessed in other studies that found a reduction in the SSI rate from 1.3 to 0.5% in patients undergoing hysterectomies (43,(46)(47)(48). Implementing surgical 'bundles' is a multidisciplinary effort involving physicians (both gynaecologists and anaesthesiologists), nurses and patients (43).…”

Section: Surgical 'Bundles'mentioning

confidence: 99%

“…Implementing surgical 'bundles' is a multidisciplinary effort involving physicians (both gynaecologists and anaesthesiologists), nurses and patients (43). The gynaecology-specific 'bundle' is extrapolated from general surgery 'bundles' on the basis of existing evidence and best practice guidelines and includes: Wipes with chlorhexidine gluconate; hair removal; preoperative warming (forced-air warming devices); skin preparation (abdominal and, specifically, vaginal preparation); change gloves before closing fascia; sterile dressing; intraoperative normothermia; antimicrobial prophylaxis; and monthly meetings to assess feedback (43,47,48). Moving forward in the SSI prevention with evidence-based 'surgical bundles' that are rapidly covering all surgical fields (4), OG departments should take into consideration the main prevention methods to build 'bundles' in reducing SSI.…”

Section: Surgical 'Bundles'mentioning

confidence: 99%

Adapting surgical ‘bundles’ to prevent surgical site infections in obstetrics and gynecology (Review)

et al. 2022

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Surgical site infections (SSIs) are a complication in any surgical field and they are responsible for 38% of surgery-related patient deaths. Identifying appropriate prophylaxis and solutions to combat SSIs is of global interest. Several studies and reports on SSI raise awareness of this costly complication, both in terms of physical and mental suffering, and as a monetary burden. Knowing the risk factors and implementing strategies to reduce SSI risk represent an adequate approach to reduce SSI incidence. General risk factors of SSI are applicable in the obstetrics and gynecology field, alongside its specific characteristics, including immunological changes occurring during pregnancy, as well as disturbances of vaginal microbiota. The risk of SSI is determined by patient factors but also by preoperative, intraoperative and postoperative care. 'Bundle' prevention strategies have been smartly adopted and their efficiency has been demonstrated in colorectal surgery, cesarean deliveries and gynecological oncology surgeries.'Bundle' measures may vary among studies, but they remain important prevention methods, which contribute to decreasing SSIs, which is a favorable outcome, and thus, are increasingly used as a routine practice. Therefore, healthcare personnel should aim for the early identification of risk factors to minimize the risk of SSI. All evidence-based methods for preventing and treating SSIs in all surgical fields should be considered to be integral components in order for the best care to be provided to patients. Contents1. Introduction 2. Risk factors 3. Prevention 4. Surgical 'bundles' 5. Conclusion

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A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications

Abstract: Objective: To evaluate the impact of a surgical site infection (SSI) prevention bundle on SSI rates after hysterectomy for benign and malignant indications at an urban academic medical center. Methods: The bundled invention was implemented for all abdominal gynecologic sur

Cited by 12 publications

References 27 publications

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal‐Approach Hysterectomy at a Midwestern Teaching Hospital

Implementing a Bundle to Improve Surgical Site Infection Rates for Patients Undergoing Nonvaginal‐Approach Hysterectomy at a Midwestern Teaching Hospital

Assessment of Bundle of Measures Perioperatively to Decrease the Incidence of Surgical Site Wound Infection in Patients Undergoing Abdominal Hysterectomies

Adapting surgical ‘bundles’ to prevent surgical site infections in obstetrics and gynecology (Review)

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