Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

Hoang, Sook C.; Klipfel, Adam; Roth, Leslie; Vrees, Mathew; Schechter, Steven; Shah, Nishit

doi:10.1016/j.amjsurg.2018.07.008

Cited by 41 publications

(36 citation statements)

References 28 publications

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“…Kim, et al [22] in a systematic review and meta-analysis of laparoscopic cholecystectomy found prophylactic antibiotic reduced superficial SSI’s but not deep SSI’s in low-risk patients. On the other hand, several studies have found benefit in colorectal surgery [23–25], neurosurgery [26], hysterectomy [27], as well as a board national surgical database [9]. In fact, in our study, compliance with the antibiotic type and timing was associated with a lower incidence of postoperative SSI, although it did not quite reach statistical significance.…”

Section: Discussioncontrasting

confidence: 65%

Prophylactic antibiotic bundle compliance and surgical site infections: an artificial neural network analysis

2019

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BackgroundBest practice “bundles” have been developed to lower the occurrence rate of surgical site infections (SSI’s). We developed artificial neural network (ANN) models to predict SSI occurrence based on prophylactic antibiotic compliance.MethodsUsing the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) Tampa General Hospital patient dataset for a six-month period, 780 surgical procedures were reviewed for compliance with SSI guidelines for antibiotic type and timing. SSI rates were determined for patients in the compliant and non-compliant groups. ANN training and validation models were developed to include the variables of age, sex, steroid use, bleeding disorders, transfusion, white blood cell count, hematocrit level, platelet count, wound class, ASA class, and surgical antimicrobial prophylaxis (SAP) bundle compliance.ResultsOverall compliance to recommended antibiotic type and timing was 92.0%. Antibiotic bundle compliance had a lower incidence of SSI’s (3.3%) compared to the non-compliant group (8.1%, p = 0.07). ANN models predicted SSI with a 69–90% sensitivity and 50–60% specificity. The model was more sensitive when bundle compliance was not used in the model, but more specific when it was. Preoperative white blood cell (WBC) count had the most influence on the model.ConclusionsSAP bundle compliance was associated with a lower incidence of SSI’s. In an ANN model, inclusion of the SAP bundle compliance reduced sensitivity, but increased specificity of the prediction model. Preoperative WBC count had the most influence on the model.

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Section: Discussioncontrasting

confidence: 65%

Prophylactic antibiotic bundle compliance and surgical site infections: an artificial neural network analysis

2019

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“…A significant decrease in infection was observed during the implementation phase and sustainability of the interventions was demonstrated in the third phase 19 . This was later supported by Hoang et al who examined bundle implementation in 1351 colorectal surgeries and found not only that infection in deep and superficial wounds was reduced but also that compliance with evidencebased practice increased and was continued 20 . The study illustrated that the small changes implemented led to significant changes in practice over time.…”

Section: Discussionmentioning

confidence: 82%

Implementing a surgical site infection care bundle: Implications for perioperative practice

Proops¹

2019

Journal of Perioperative Nursing

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“…[42][43][44] ERAS or bundling of perioperative care has gained interest and has had promising results in specific fields but needs further development and investigation prior to widespread adoption. [45][46][47] SSI is a clinical diagnosis based on history and physical examination findings and can be confirmed with cultures. Criteria for diagnosis and classification of superficial incisional, deep incisional, and organ/space infections can be found in Table 1.…”

Section: Risk Factorsmentioning

confidence: 99%

Surgical Wound Infections

Barry

2021

Physician Assistant Clinics

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The work of Louis Pasteur, Joseph Lister, and Robert Koch in the late nineteenth century has informed the role of infection on surgical outcomes and ultimately served as the foundation for the transformation of surgical medicine. Louis Pasteur was a French scientist whose studies in fermentation, anthrax, silkworm disease, chicken cholera, and rabies led to the development of the germ theory of fermentation and subsequently the germ theory of disease. 1-3 In his early fermentation studies, he proposed that microorganisms caused fermentation and decomposition during a time when it was widely believed to be solely a chemical reaction. He developed techniques of sterilizing equipment in the laboratory that later would translate into similar applications in the surgical setting. British surgeon Joseph Lister brought his experience and observations as a surgeon and his belief in the germ theory of disease to his development of aseptic techniques using carbolic acid in the surgical setting. 4 He developed a set of principles in asepsis to be used in approach to surgery and surgical wounds: (1) destroy germs on the patient's skin, the surgeon's hands, the instruments, and the area surrounding the surgical site; (2) prevent germs from the air from entering the wound during surgery; and (3) prevent germs from entering the wound after surgery. 3-6

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Colon and rectal surgery surgical site infection reduction bundle: To improve is to change

Cited by 41 publications

References 28 publications

Prophylactic antibiotic bundle compliance and surgical site infections: an artificial neural network analysis

Prophylactic antibiotic bundle compliance and surgical site infections: an artificial neural network analysis

Implementing a surgical site infection care bundle: Implications for perioperative practice

Surgical Wound Infections

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