The Role of Bundle Size for Preventing Surgical Site Infections after Colorectal Surgery: Is More Better?

Tomsic, Ivonne; Chaberny, Iris F.; Heinze, Nicole; Krauth, Christian; Schock, Bettina; Lengerke, Thomas von

doi:10.1007/s11605-018-3670-8

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…Our results are in line with those found by a recent meta-analysis of 35 studies on the effectiveness of SSI prevention through bundles in colorectal surgery [3]. Tomsic et al performed a supplementary analysis of the studies included in the meta-analysis, to evaluate whether the number of components included in the bundled interventions related to effectiveness in reducing SSIs of all wound depths [17]. The largest effect on SSI risk was found for bundles with more than 11 elements, compared to smaller bundles.…”

Section: Discussionsupporting

confidence: 90%

Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

Vicentini

Scacchi

Corradi

et al. 2021

American Journal of Infection Control

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Section: Discussionsupporting

confidence: 90%

Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

Vicentini

Scacchi

Corradi

et al. 2021

American Journal of Infection Control

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“…That is, models such as COM-B were developed to identify determinants for individual behaviours within change intervention design processes (13,14) for the simple reason that different determinants may be important for different behaviours. While this argument certainly holds validity, a key trend in SSI prevention has been the use of bundles (37)(38)(39)(40)(41), i.e., sets of "…evidence-based interventions...that, when implemented together, will result in signi cantly better outcomes than when implemented individually" (42). Thus, compliance is increasingly de ned in terms of more than one measure simultaneously.…”

Section: Discussionmentioning

confidence: 99%

First questionnaire with measurement equivalence between physicians and nurses to assess individual determinants of compliance with surgical site infection prevention: cross-sectional survey results from the WACH-study

Krosta,

Tomsic,

Maike

et al. 2023

Preprint

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Background Compliance to prevent healthcare-associated infections varies between physicians and nurses. Understanding these differences is the key to adapt, i.e., tailor interventions to promote compliance. To measure determinants to be taken into account in tailoring processes, reliable and valid instruments with measurement equivalence (ME) across professional groups are needed. Aim To determine the reliability, validity, and ME of questionnaire scales to assess determinants of compliance to prevent surgical site infections (SSI) based on the Capability|Opportunity| Motivation–Behaviour model (COM-B), and explore their associations with self-reported compliance. Methods Self-reported SSI-preventive compliance and COM-B-determinants were assessed in a questionnaire survey of 90 physicians and 193 nurses working in nine departments in six German hospitals outside the university sector. Single- and multi-group confirmatory factor analyses, t-tests, and multiple linear regression analyses were performed. Findings: Scales for individual determinants (capability, motivation, planning) but not environmental determinants (opportunities) showed reliability and validity among both physicians and nurses, and ME across these groups. No group differences were found in compliance and determinants. Capability (β = .301) and planning (β = .201) showed theory-conform associations with self-reported compliance among nurses, not physicians. Additionally, both tended to mediate the association of motivation. Conclusion The scales for motivation, capability, and planning regarding SSI-preventive compliance rendered reliable and valid scores for physicians and nurses in surgery. Due to ME, they provide true comparisons between both groups in German hospitals. Such scales for environmental determinants (opportunities) have yet to be developed. Associations of individual determinants with self-reported compliance were in line with theory among nurses.

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“…A bundle generally uses more than three evidence-based measures which implemented together are more effective than in isolation. Recently, Tomsic, et al suggested that bundle size itself is important and in their analysis suggested that a bundle with more than eleven items have additional standalone benefit in surgical site reduction [75] .…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

2022

J Surg

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Background: Surgical Site Infections (SSI) are a major source of post-operative complications and potentially affect oncological outcomes. Reducing SSI is multi-factorial, best served by the additive affect of individual wound bundle elements. With changing strategies and novel innovations ongoing meta-analyses are needed to inform current practice. This study undertook a meta-analysis of existing wound bundles impact on SSI in colorectal surgery.Methods: A PROSPERO-registered (ID: CRD42018104923) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using databases PubMed, Scopus and Web of Science, from January 2008 to July 2018, was undertaken. Articles scoring ≥ 17 using Methodological Index for non-randomised Studies (MINORS) criteria were included.Results: 5,104 articles were reviewed, and 27 studies met inclusion criteria with a total cohort of 23851 patients. Wound bundles significantly decreased SSI rates from 17.5% to 9.7%. Sub-analysis identified greatest impact on superficial SSI (risk reduction of 54%; p<0.00001) and organ-space infections (risk reduction 42%; p=0.0006).Wound bundles also significantly reduced hospital length of stay (MD = −0.79; p<0.00001). Conclusions:Colorectal wound bundles significantly reduce the risk of SSI and length of hospital stay. They should become routine in colorectal surgery. Future work encompasses the need for standardisation of wound complications, standardised follow-up of patients and internationally agreed research definitions.

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The Role of Bundle Size for Preventing Surgical Site Infections after Colorectal Surgery: Is More Better?

Cited by 15 publications

References 4 publications

Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

Interrupted time series analysis of the impact of a bundle on surgical site infections after colon surgery

First questionnaire with measurement equivalence between physicians and nurses to assess individual determinants of compliance with surgical site infection prevention: cross-sectional survey results from the WACH-study

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

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