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 design...
| Autores: | , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p5033 |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/5033 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200828427&doi=10.1093%2fbjsopen%2fzrae080&partnerID=40&md5=f7665178411c870c65edcb1fa36e212f |
| Access Level: | acceso abierto |
| Palabra clave: | Aged Antibiotic Prophylaxis Cohort Studies Colon Colorectal Surgery Elective Surgical Procedures Female Humans Length of Stay Male Middle Aged Patient Care Bundles Rectum Surgical Wound Infection aged antibiotic prophylaxis antisepsis Article Bacteroides body temperature Candida Clostridium cohort analysis colon surgery colorectal surgery compliance (physical) controlled study deep surgical site infection drug surveillance program Enterococcus faecalis Enterococcus faecium Escherichia coli female Gram negative bacterium Gram positive bacterium human intensive care unit intervention study Klebsiella laparoscopy major clinical study male methicillin resistant Staphylococcus aureus microbiology minimally invasive surgery mortality rate multicenter study organ space infection prophylaxis Pseudomonas rectum surgery Streptococcus superficial surgical site infection surgeon surgical infection adverse event care bundle clinical trial co |
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Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort studyFlores-Yelamos, MGomila-Grange, ABadia, JMAlmendral, AVázquez, AParés, DPascual, MLimón, EPujol, MJuvany, MAgedAntibiotic ProphylaxisCohort StudiesColonColorectal SurgeryElective Surgical ProceduresFemaleHumansLength of StayMaleMiddle AgedPatient Care BundlesRectumSurgical Wound Infectionagedantibiotic prophylaxisantisepsisArticleBacteroidesbody temperatureCandidaClostridiumcohort analysiscolon surgerycolorectal surgerycompliance (physical)controlled studydeep surgical site infectiondrug surveillance programEnterococcus faecalisEnterococcus faeciumEscherichia colifemaleGram negative bacteriumGram positive bacteriumhumanintensive care unitintervention studyKlebsiellalaparoscopymajor clinical studymalemethicillin resistant Staphylococcus aureusmicrobiologyminimally invasive surgerymortality ratemulticenter studyorgan space infectionprophylaxisPseudomonasrectum surgeryStreptococcussuperficial surgical site infectionsurgeonsurgical infectionadverse eventcare bundleclinical trialcoBackground: 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 UNIV PRESS2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://i3pt.portalinvestigacion.com/publicaciones/5033https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200828427&doi=10.1093%2fbjsopen%2fzrae080&partnerID=40&md5=f7665178411c870c65edcb1fa36e212fBJS OpenISSN: 24749842reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulíinstname:Institut d'Investigació i Innovació Parc Taulí (I3PT)Inglésinfo:eu-repo/semantics/openAccessoai:i3pt.fundanetsuite.com:p50332026-06-21T15:30:37Z |
| 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, M Aged Antibiotic Prophylaxis Cohort Studies Colon Colorectal Surgery Elective Surgical Procedures Female Humans Length of Stay Male Middle Aged Patient Care Bundles Rectum Surgical Wound Infection aged antibiotic prophylaxis antisepsis Article Bacteroides body temperature Candida Clostridium cohort analysis colon surgery colorectal surgery compliance (physical) controlled study deep surgical site infection drug surveillance program Enterococcus faecalis Enterococcus faecium Escherichia coli female Gram negative bacterium Gram positive bacterium human intensive care unit intervention study Klebsiella laparoscopy major clinical study male methicillin resistant Staphylococcus aureus microbiology minimally invasive surgery mortality rate multicenter study organ space infection prophylaxis Pseudomonas rectum surgery Streptococcus superficial surgical site infection surgeon surgical infection adverse event care bundle clinical trial co |
| 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, M Gomila-Grange, A Badia, JM Almendral, A Vázquez, A Parés, D Pascual, M Limón, E Pujol, M Juvany, M |
| author |
Flores-Yelamos, M |
| author_facet |
Flores-Yelamos, M Gomila-Grange, A Badia, JM Almendral, A Vázquez, A Parés, D Pascual, M Limón, E Pujol, M Juvany, M |
| author_role |
author |
| author2 |
Gomila-Grange, A Badia, JM Almendral, A Vázquez, A Parés, D Pascual, M Limón, E Pujol, M Juvany, M |
| author2_role |
author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Aged Antibiotic Prophylaxis Cohort Studies Colon Colorectal Surgery Elective Surgical Procedures Female Humans Length of Stay Male Middle Aged Patient Care Bundles Rectum Surgical Wound Infection aged antibiotic prophylaxis antisepsis Article Bacteroides body temperature Candida Clostridium cohort analysis colon surgery colorectal surgery compliance (physical) controlled study deep surgical site infection drug surveillance program Enterococcus faecalis Enterococcus faecium Escherichia coli female Gram negative bacterium Gram positive bacterium human intensive care unit intervention study Klebsiella laparoscopy major clinical study male methicillin resistant Staphylococcus aureus microbiology minimally invasive surgery mortality rate multicenter study organ space infection prophylaxis Pseudomonas rectum surgery Streptococcus superficial surgical site infection surgeon surgical infection adverse event care bundle clinical trial co |
| topic |
Aged Antibiotic Prophylaxis Cohort Studies Colon Colorectal Surgery Elective Surgical Procedures Female Humans Length of Stay Male Middle Aged Patient Care Bundles Rectum Surgical Wound Infection aged antibiotic prophylaxis antisepsis Article Bacteroides body temperature Candida Clostridium cohort analysis colon surgery colorectal surgery compliance (physical) controlled study deep surgical site infection drug surveillance program Enterococcus faecalis Enterococcus faecium Escherichia coli female Gram negative bacterium Gram positive bacterium human intensive care unit intervention study Klebsiella laparoscopy major clinical study male methicillin resistant Staphylococcus aureus microbiology minimally invasive surgery mortality rate multicenter study organ space infection prophylaxis Pseudomonas rectum surgery Streptococcus superficial surgical site infection surgeon surgical infection adverse event care bundle clinical trial co |
| 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 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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article |
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publishedVersion |
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https://i3pt.portalinvestigacion.com/publicaciones/5033 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200828427&doi=10.1093%2fbjsopen%2fzrae080&partnerID=40&md5=f7665178411c870c65edcb1fa36e212f |
| url |
https://i3pt.portalinvestigacion.com/publicaciones/5033 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85200828427&doi=10.1093%2fbjsopen%2fzrae080&partnerID=40&md5=f7665178411c870c65edcb1fa36e212f |
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Inglés |
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Inglés |
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info:eu-repo/semantics/openAccess |
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openAccess |
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OXFORD UNIV PRESS |
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OXFORD UNIV PRESS |
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BJS Open ISSN: 24749842 reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí instname:Institut d'Investigació i Innovació Parc Taulí (I3PT) |
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Institut d'Investigació i Innovació Parc Taulí (I3PT) |
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r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
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