SSI prevention bundle improved outcomes among orthopedic surgery patients
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Key takeaways:
- Adherence to an antimicrobial prophylaxis bundle reduced SSI and mortality rates among patients undergoing orthopedic surgery.
- The bundle was most beneficial to patients undergoing hip and knee arthroplasties.
SAN ANTONIO — Rates of surgical site infections drastically improved after implementing a comprehensive prevention bundle, researchers reported at the Association for Professionals in Infection Control and Epidemiology annual meeting.
“In 2016-2017, many national organizations ... released evidence-based guidelines for surgical site infection (SSI) prevention strategies,” Aarikha P. D’Souza, BS, MPH, FAPIC, CIC, Arizona regional infection prevention director at Banner Health Corporateu, told Healio.
“Our organization at the time, outside of the Surgical Care Improvement Project, did not have a standardized and structured SSI prevention bundle at the time. We utilized our organization’s structure of Clinical Consensus Groups (CCGs) and partnered with the Surgery CCG and with various perioperative nurses, surgeons, anesthesia and pharmacist stakeholders to review current literature,” D’Souza said.
Through these efforts, the researchers created an overall practice guideline and then developed the tools to implement the guidelines and measurements to monitor and maintain successes.
They assessed the effect of the bundle, which focused heavily on being an antimicrobial prophylaxis bundle, on more than 57,000 surgical cases from between January 2019 and December 2023. Procedures included in the study were hip and knee arthroplasty, colorectal surgery and abdominal hysterectomy across 30 facilities.
“The work really boiled down to us getting together and formulating our own approach to utilize research findings and evidence-based guidelines to develop our own SSI prevention bundle for our health system,” she said.
D’Souza explained that the aim of the SSI prevention bundle was to drive improvements with various process measures and, hopefully, decrease SSI rates and standardized infection ratios. After applying the bundle, the team monitored and measured the overall surgical antimicrobial prophylaxis bundle, as well as adherence to the appropriate selection of preoperative antibiotics, dose, administration times and re-dose.
Overall, they found that increased adherence to the bundle was the most beneficial to patients undergoing orthopedic procedures — primarily hip and knee arthroplasties. Specifically, the study showed that for hip arthroplasty procedures, there was a significant reduction in the SSI rates of 32.8% and 48.3% with the standardized infection ratio (SIR), whereas knee arthroplasty procedures had significant reductions of 15.2% with the SSI rates, and an SIR decrease of 33.1%.
The bundle, when used in hip arthroplasty procedures, also resulted in statistically significant reduction in the average 30-day readmission rates from 11% to 7% and mortality rates from 2.6% to 1.3%.
Additionally, the researchers found that the bundle was beneficial in colorectal surgeries and abdominal hysterectomy procedures — SSI rates decreased by 17.4% and SIR by 8.11%. And overall, 30-day readmissions decreased from 10.9% to 7% with bundle compliance.
D’Souza explained that although “it takes a village” for these bundles to go from a concept to implementation, it is possible for facilities all over to deploy them with the same success through leader buy in, along with surgeon and anesthesia champions at the facility level to drive compliance with various process measure.
“This project shows the value of intense focus on a specific set of process measures to influence not just infection rates, but also other important quality metrics,” Professionals in Infection Control and Epidemiology (APIC) president Tania Bubb, PhD, RN, CIC, FAPIC, said in a press release. “We are grateful to Banner Health for their exceptional patient safety work and for sharing their success at the APIC Conference.”
References:
- D’Souza A, et al. ISR 11. Presented at: APIC 2024; June 3-5, 2024; San Antonio (hybrid).
- Surgical site infection rates and other secondary outcomes decrease dramatically at multi-state hospital system through standardized, preoperative, surgical, antibiotic practices. [Press release made available to media but not published online].
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D’Souza A, et al. ISR 11. Presented at: APIC 2024; June 3-5, 2024; San Antonio (hybrid).
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