Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study

Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level.Methods: A pragmatic, multicentre cohort study was designe...

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Autores: Flores-Yelamos, Miriam, Gomila Grange, Aina, Badia, Josep M., Almendral, Alexander, Vázquez, Ana, Parés, David, Pascual Berniola, Marta, Limón, Enrique, Pujol Rojo, Miquel, Juvany, Montserrat
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/215105
Acceso en línea:https://hdl.handle.net/2445/215105
Access Level:acceso abierto
Palabra clave:Infeccions quirúrgiques
Antibiòtics
Cirurgia colorectal
Còlon
Surgical wound infection
Antibiotics
Colorectal surgery
Colon
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spelling Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort studyFlores-Yelamos, MiriamGomila Grange, AinaBadia, Josep M.Almendral, AlexanderVázquez, AnaParés, DavidPascual Berniola, MartaLimón, EnriquePujol Rojo, MiquelJuvany, MontserratInfeccions quirúrgiquesAntibiòticsCirurgia colorectalCòlonSurgical wound infectionAntibioticsColorectal surgeryColonBackground: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level.Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate.Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection.Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.Oxford University Press2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/215105Articles publicats en revistes (Infermeria de Salut Pública, Salut mental i Maternoinfantil)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1093/bjsopen/zrae080BJS Open, 2024, vol. 8, num.4https://doi.org/10.1093/bjsopen/zrae080cc-by (c) Flores-Yelamos, M. et al., 2024http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2151052026-05-27T06:46:51Z
dc.title.none.fl_str_mv Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
title Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
spellingShingle Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
Flores-Yelamos, Miriam
Infeccions quirúrgiques
Antibiòtics
Cirurgia colorectal
Còlon
Surgical wound infection
Antibiotics
Colorectal surgery
Colon
title_short Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
title_full Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
title_fullStr Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
title_full_unstemmed Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
title_sort Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
dc.creator.none.fl_str_mv Flores-Yelamos, Miriam
Gomila Grange, Aina
Badia, Josep M.
Almendral, Alexander
Vázquez, Ana
Parés, David
Pascual Berniola, Marta
Limón, Enrique
Pujol Rojo, Miquel
Juvany, Montserrat
author Flores-Yelamos, Miriam
author_facet Flores-Yelamos, Miriam
Gomila Grange, Aina
Badia, Josep M.
Almendral, Alexander
Vázquez, Ana
Parés, David
Pascual Berniola, Marta
Limón, Enrique
Pujol Rojo, Miquel
Juvany, Montserrat
author_role author
author2 Gomila Grange, Aina
Badia, Josep M.
Almendral, Alexander
Vázquez, Ana
Parés, David
Pascual Berniola, Marta
Limón, Enrique
Pujol Rojo, Miquel
Juvany, Montserrat
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Infeccions quirúrgiques
Antibiòtics
Cirurgia colorectal
Còlon
Surgical wound infection
Antibiotics
Colorectal surgery
Colon
topic Infeccions quirúrgiques
Antibiòtics
Cirurgia colorectal
Còlon
Surgical wound infection
Antibiotics
Colorectal surgery
Colon
description Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level.Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate.Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection.Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.
publishDate 2024
dc.date.none.fl_str_mv 2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/215105
url https://hdl.handle.net/2445/215105
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1093/bjsopen/zrae080
BJS Open, 2024, vol. 8, num.4
https://doi.org/10.1093/bjsopen/zrae080
dc.rights.none.fl_str_mv cc-by (c) Flores-Yelamos, M. et al., 2024
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Flores-Yelamos, M. et al., 2024
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv Articles publicats en revistes (Infermeria de Salut Pública, Salut mental i Maternoinfantil)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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