Perioperative care bundles for the prevention of surgical-site infections: meta-analysis

Wolfhagen, Niels; Boldingh, Quirine J J; Boermeester, Marja A.; Jonge, Stijn De

doi:10.1093/bjs/znac196

Cited by 27 publications

(18 citation statements)

References 49 publications

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“…First, the evidence-based performance measures in this study are highly recommended by most guidelines and should be recommended for all surgical procedures [ 1 , 3 , 6 ]. However, the risk factors of SSI are complex and multifactorial [ 3 , 6 , 12 ], and this study did not analyze all the perioperative risk factors. Second, a meta-analysis has indicated that the effect of perioperative care bundles for the prevention of SSIs is inconsistent across randomized control trials [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the risk factors of SSI are complex and multifactorial [ 3 , 6 , 12 ], and this study did not analyze all the perioperative risk factors. Second, a meta-analysis has indicated that the effect of perioperative care bundles for the prevention of SSIs is inconsistent across randomized control trials [ 12 ]. No strong evidence for the characteristics of effective preventive care bundles was identified.…”

Section: Discussionmentioning

confidence: 99%

“…No strong evidence for the characteristics of effective preventive care bundles was identified. Larger bundles were not associated with a better effect, but the better effect may be achieved if the care bundle contains a high proportion of evidence-based interventions [ 12 ]. Although we have achieved a success of the limited performance measures in this study, it is necessary for the societies of surgery and infection prevention to identify other effective measures that contribute to SSI prevention and outcome performance.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the improvement projects using systematic approaches, or care bundles that incorporate best practices for the perioperative care, have been successful in reducing SSI rates to varying degrees [ 9 , 11 ]. A meta-analysis has indicated that the effects of perioperative care bundles for the prevention of SSIs are inconsistent among many randomized control trials [ 12 ]. Prevention bundle will not result in decreased SSI rates, if the overall compliance or systemic adaptation by healthcare organizations is insufficient [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

et al. 2022

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Background: SSIs (surgical site infections) are associated with increased rates of morbidity and mortality. The traditional quality improvement strategies focusing on individual performance did not achieve sustainable improvement. This study aimed to implement the Six Sigma DMAIC method to reduce SSIs and to sustain improvements in surgical quality. The surgical procedures, clinical data, and surgical site infections were collected among 42,233 hospitalized surgical patients from 1 January 2019 to 31 December 2020. Following strengthening leadership and empowering a multidisciplinary SSI prevention team, DMAIC (Define, Measure, Analyze, Improve, and Control) was used as the performance improvement model. An evidence-based prevention bundle for reduction of SSI was adopted as performance measures. Environmental monitoring and antimicrobial stewardship programs were strengthened to prevent the transmission of multi-drug resistant microorganisms. Process change was integrated into a clinical pathway information system. Improvement cycles by corrective actions for the risk events of SSIs were implemented to ensure sustaining improvements. We have reached the targets of the prevention bundle elements in the post-intervention period in 2020. The carbapenem resistance rates of Enterobacteriaceae and P. aeruginosa were lower than 10%. A significant 22.2% decline in SSI rates has been achieved, from 0.9% for the pre-intervention period in 2019 to 0.7% for the post-intervention period in 2020 (p = 0.004). Application of the Six Sigma DMAIC approach could significantly reduce the SSI rates. It also could help hospital administrators and quality management personnel to create a culture of patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

et al. 2022

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“…4–6 The number and type of measures included in a SSI bundle can vary considerably, but some measures are mentioned more often. 7 These measures are focused on surgical-site preparation, hair removal, antibiotic prophylaxis, wound closure, normothermia and glycaemic control. 7–10 …”

Section: Introductionmentioning

confidence: 99%

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before–after study in operating theatres in the Netherlands

et al. 2023

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ObjectivesTo assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT).DesignMulticentre before–after study.SettingThis study was performed in four Dutch hospitals.InterventionThe QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia.Poissonand logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures).ResultsNot all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration.ConclusionThis study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.

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Evaluation of an Evidence‐Based Care Bundle for Preventing Hospital‐Acquired Pressure Injuries in High‐Risk Surgical Patients

Aloweni,

Lim,

Agus

et al. 2023

AORN Journal

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The aim of this study was to evaluate the effectiveness of an evidence‐based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi‐experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure‐relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.

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Perioperative care bundles for the prevention of surgical-site infections: meta-analysis

Cited by 27 publications

References 49 publications

Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

Sustaining Improvements of Surgical Site Infections by Six Sigma DMAIC Approach

Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before–after study in operating theatres in the Netherlands

Evaluation of an Evidence‐Based Care Bundle for Preventing Hospital‐Acquired Pressure Injuries in High‐Risk Surgical Patients

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