PMID- 36917127
OWN - NLM
STAT- MEDLINE
DCOM- 20230427
LR  - 20231123
IS  - 1743-9159 (Electronic)
IS  - 1743-9191 (Print)
IS  - 1743-9159 (Linking)
VI  - 109
IP  - 4
DP  - 2023 Apr 1
TI  - Leveraging a nationwide infection surveillance program to implement a colorectal 
      surgical site infection reduction bundle: a pragmatic, prospective, and 
      multicenter cohort study.
PG  - 737-751
LID - 10.1097/JS9.0000000000000277 [doi]
AB  - BACKGROUND: Bundled interventions usually reduce surgical site infection (SSI) 
      when implemented at single hospitals, but the feasibility of their implementation 
      at the nationwide level and their clinical results are not well established. 
      MATERIALS AND METHODS: Pragmatic interventional study to analyze the 
      implementation and outcomes of a colorectal surgery care bundle within a 
      nationwide quality improvement program. The bundle consisted of antibiotic 
      prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation, 
      laparoscopy, normothermia, and a wound retractor. Control group (CG) and 
      Intervention group (IG) were compared. Overall SSI, superficial (S-SSI), deep 
      (D-SSI), and organ/space (O/S-SSI) rates were analyzed. Secondary endpoints 
      included microbiology, 30-day mortality, and length of hospital stay. RESULTS: A 
      total of 37 849 procedures were included, 19 655 in the CG and 18 194 in the IG. 
      In all, 5462 SSIs (14.43%) were detected: 1767 S-SSI (4.67%), 847 D-SSI (2.24%), 
      and 2838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), odds 
      ratio (OR) of 0.503 [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), 
      OR of 0.602 [0.556-0.652]. The overall SSI rate was 16.71% when no measure was 
      applied and 6.23% when all six were used. Bundle implementation reduced the 
      probability of overall SSI (OR: 0.331; CI 95 : 0.242-0.453), and also O/S-SSI 
      rate (OR: 0.643; CI 95 : 0.416-0.919). In the univariate analysis, all measures 
      except normothermia were associated with a reduction in overall SSI, while only 
      laparoscopy, OAP, and mechanical bowel preparation were related to a decrease in 
      O/S-SSI. Laparoscopy, wound retractor, and OAP decreased overall SSI and O/S-SSI 
      in the multivariate analysis. CONCLUSIONS: In this cohort study, the application 
      of a specific care bundle within a nationwide nosocomial infection surveillance 
      system proved feasible and resulted in a significant reduction in overall and 
      O/S-SSI rates in the elective colon and rectal surgery. The OR for SSI fell 
      between 1.5 and 3 times after the implementation of the bundle.
CI  - Copyright (c) 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Badia, Josep M
AU  - Badia JM
AUID- ORCID: 0000-0003-2928-5233
AD  - Department of Surgery, Hospital General de Granollers, Granollers.
AD  - School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del 
      Valles.
FAU - Arroyo-Garcia, Nares
AU  - Arroyo-Garcia N
AUID- ORCID: 0000-0002-7345-6143
AD  - Department of Surgery, Hospital General de Granollers, Granollers.
AD  - School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del 
      Valles.
FAU - Vazquez, Ana
AU  - Vazquez A
AUID- ORCID: 0000-0001-6732-1667
AD  - Servei d'Estadistica Aplicada, Universitat Autonoma de Barcelona, Bellaterra, 
      Barcelona.
FAU - Almendral, Alexander
AU  - Almendral A
AUID- ORCID: 0000-0002-5459-3919
AD  - VINCat Program, Catalonia.
FAU - Gomila-Grange, Aina
AU  - Gomila-Grange A
AUID- ORCID: 0000-0001-6979-9269
AD  - Department of Infectious Diseases, Hospital Universitari Parc Tauli, Sabadell.
FAU - Fraccalvieri, Domenico
AU  - Fraccalvieri D
AUID- ORCID: 0000-0003-3920-6199
AD  - Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet de 
      Llobregat.
FAU - Pares, David
AU  - Pares D
AD  - Colorectal Surgery Unit, Department of Surgery, Hospital Universitari Germans 
      Trias i Pujol, Badalona, Barcelona.
AD  - Universitat Autonoma de Barcelona, Catalonia.
FAU - Abad-Torrent, Ana
AU  - Abad-Torrent A
AUID- ORCID: 0000-0002-5448-0113
AD  - Department of Anaesthesiology, Hospital Universitari Vall d'Hebron.
FAU - Pascual, Marta
AU  - Pascual M
AUID- ORCID: 0000-0003-0849-9048
AD  - Department of Surgery, Hospital del Mar.
FAU - Solis-Pena, Alejandro
AU  - Solis-Pena A
AUID- ORCID: 0000-0001-5536-9559
AD  - Department of Surgery, Hospital Universitari Vall d'Hebron.
FAU - Puig-Asensio, Mireia
AU  - Puig-Asensio M
AUID- ORCID: 0000-0002-0722-2218
AD  - Department of Infectious Diseases, Hospital Universitari de Bellvitge, 
      L'Hospitalet de Llobregat, Barcelona.
AD  - Centro de Investigacion Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC, 
      CB21/13/00009), Instituto de Salud Carlos III, Madrid.
FAU - Pera, Miguel
AU  - Pera M
AUID- ORCID: 0000-0001-7764-6481
AD  - Department of Surgery, Hospital del Mar.
FAU - Gudiol, Francesc
AU  - Gudiol F
AUID- ORCID: 0000-0002-9940-3461
AD  - VINCat Program, Catalonia.
FAU - Limon, Enric
AU  - Limon E
AUID- ORCID: 0000-0002-5396-1521
AD  - VINCat Program, Catalonia.
AD  - Universitat de Barcelona.
FAU - Pujol, Miquel
AU  - Pujol M
AUID- ORCID: 0000-0002-6475-6208
AD  - VINCat Program, Catalonia.
AD  - Centro de Investigacion Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC, 
      CB21/13/00009), Instituto de Salud Carlos III, Madrid.
AD  - Department of Infectious Diseases, Hospital Universitari de Bellvitge.
AD  - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
CN  - Members of the VINCat Colorectal Surveillance Team
CN  - VINCat Program*
LA  - eng
SI  - ClinicalTrials.gov/NCT04129177
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230401
PL  - United States
TA  - Int J Surg
JT  - International journal of surgery (London, England)
JID - 101228232
SB  - IM
MH  - Humans
MH  - Cohort Studies
MH  - Prospective Studies
MH  - *Surgical Wound Infection/epidemiology/prevention & control
MH  - *Colorectal Neoplasms/surgery
PMC - PMC10389383
COIS- The authors declare no conflict of interest. All authors submitted the ICMJE Form 
      for Disclosure of Potential Conflicts of Interest. Sponsorships or competing 
      interests that may be relevant to content are disclosed at the end of this 
      article.
EDAT- 2023/03/15 06:00
MHDA- 2023/04/27 06:42
PMCR- 2023/07/31
CRDT- 2023/03/14 11:42
PHST- 2022/10/21 00:00 [received]
PHST- 2023/01/26 00:00 [accepted]
PHST- 2023/04/27 06:42 [medline]
PHST- 2023/03/15 06:00 [pubmed]
PHST- 2023/03/14 11:42 [entrez]
PHST- 2023/07/31 00:00 [pmc-release]
AID - 01279778-202304000-00011 [pii]
AID - 10.1097/JS9.0000000000000277 [doi]
PST - epublish
SO  - Int J Surg. 2023 Apr 1;109(4):737-751. doi: 10.1097/JS9.0000000000000277.