The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology

Abstract

Background Surgical site infections (SSI) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery. Methods Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 hours; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (4/1/14–6/30/14) while the post-intervention SSI rate was determined prospectively (2/16/15–10/15/15). The main outcome was the overall SSI rate with secondary outcomes including the rate of superficial, deep, incisional and organ space infection as well as the bundle’s cost-effectiveness. Results A total of 232 baseline and 555 post-intervention patients were included. There were no differences between baseline and post-intervention groups with regard to median BMI, surgical approach, receipt of preoperative chemotherapy and/or radiation therapy and cases including bowel surgery. Overall SSI rate decreased significantly from baseline (12.5%) to post-intervention (7.4%) (OR 0.56 [0.37–0.85]; p=0.01). A 40% decrease was noted in the rate of superficial and deep infections (9.5% vs. 5.9%; OR 0.60 [0.38–0.97]; p=0.04) and SSI after open surgery (21.4% vs. 13.2%; OR 0.56 [0.34–0.92]; p=0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625/month. Conclusions This bundled intervention led to a significant decrease in the overall SSI rate and was cost-effective. The largest decreases in SSI were in incisional infections and following open surgery.

The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis

“…– 15 , 17 –44,46–49,51–59,61–120,122–133,135–140,142–152 The final group of articles also included 3 randomized controlled trials (2.1%), 121,134,141 2 cluster-randomized controlled trials (1.4%), 50,60 and 1 time-series analysis (0.7%). 45 Moreover, 109 studies (75.7%) were performed in high income settings, 8 , 10 – 12 , 14 , 15 , 17 , 18 , 20 , 21 , 23 – 30 , 34 –45,47,48,50–53,55–57,60,64–68,72–77,79–82,85–91,93–97,99–101,103–120,122,124–131,134,138,140,143,144,146–152 26 studies (18.1%) were conducted in upper middle income settings, 9 , 13 , 22 , 31 – 33 ,59,61–63,69–71,78,92,98,102,121,123,132,133,135,137,139,141,145 and 9 studies (6.3%) were conducted in lower middle income countries 19 Fig.…”

“…S3a) 9 11 , 14 , 15 , 17 , 21 , 23 , 29 , 37 , 39 ,51,55,56,65,67,72,77,80,86,88,91,93,94,100,104,105,110,114,117,118,124,130,134,145,147,150 The pooled RR of the before-and-after studies was 0.461 (95% CI, 0.389–0.546), with an overall heterogeneity of I 2 =66.4%. A significant increase of SSI rates associated with a multifaceted intervention (RR, 1.565; 95% CI, 1.015–2.412) was reported in 1 RCT.…”

Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia–Pacific Region

“…Prevention bundles should be constructed based on identified local gaps that are thought to be contributing to higher-than-desirable SSI rates [63]. Consistent use of care bundles has been shown to achieve substantial SSI rate reductions and healthcare cost benefits [64][65][66][67][68][69][70]. Use of bundles in APAC countries (e.g.…”

Choosing Wisely: Decreasing the incidence of perioperative blood transfusions in gynecologic oncology

“…Surgical site infections were defined as an infection of the surgical incision or organ space requiring antibiotics within 30 days of surgery. [13] Preoperative hgb was obtained within 30 days of surgery. Race and ethnicity were extracted from the medical record and were self-reported by patients.…”