Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

Badia, Josep M.; Arroyo-García, Nares; Vázquez, Ana; Almendral, Alexander; Gomila-Grange, Aina; Fraccalvieri, Domenico; Parés, David; Abad-Torrent, Ana; Pascual, Marta; Solís-Peña, Alejandro; Puig-Asensio, Mireia; Pera Roman, Miguel; Gudiol, Francesc; Limón, Enric; Pujol, Miquel; VINCat Program

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

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dc.contributor.author Badia, Josep M.
dc.contributor.author Arroyo-García, Nares
dc.contributor.author Vázquez, Ana
dc.contributor.author Almendral, Alexander
dc.contributor.author Gomila-Grange, Aina
dc.contributor.author Fraccalvieri, Domenico
dc.contributor.author Parés, David
dc.contributor.author Abad-Torrent, Ana
dc.contributor.author Pascual, Marta
dc.contributor.author Solís-Peña, Alejandro
dc.contributor.author Puig-Asensio, Mireia
dc.contributor.author Pera Roman, Miguel
dc.contributor.author Gudiol, Francesc
dc.contributor.author Limón, Enric
dc.contributor.author Pujol, Miquel
dc.contributor.author VINCat Program
dc.date.accessioned 2024-03-20T13:50:10Z
dc.date.available 2024-03-20T13:50:10Z
dc.date.issued 2023
dc.description.abstract 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. Trial registration: ClinicalTrials.gov NCT04129177.
dc.format.mimetype application/pdf
dc.identifier.citation Badia JM, Arroyo-Garcia N, Vázquez A, Almendral A, Gomila-Grange A, Fraccalvieri D, et al. Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study. Int J Surg. 2023 Apr 1;109(4):737-51. DOI: 10.1097/JS9.0000000000000277
dc.identifier.doi http://dx.doi.org/10.1097/JS9.0000000000000277
dc.identifier.issn 1743-9191
dc.identifier.uri http://hdl.handle.net/10230/59508
dc.language.iso eng
dc.publisher Wolters Kluwer (LWW)
dc.relation.ispartof Int J Surg. 2023 Apr 1;109(4):737-51
dc.rights © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/.
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.subject.keyword Bundle
dc.subject.keyword Colorectal surgery
dc.subject.keyword Mechanical bowel preparation
dc.subject.keyword Normothermia
dc.subject.keyword Oral antibiotic prophylaxis
dc.subject.keyword Surgical site infection
dc.subject.keyword Surveillance program
dc.subject.keyword Systemic antibiotic prophylaxis
dc.subject.keyword Wound retractor
dc.title Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/publishedVersion

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