Care Bundle in Reducing Surgical Site Infection in Lower Gastrointestinal Surgeries: A Retrospective Analysis at a Tertiary Care Hospital, Ernakulam, Kerala

Abstract

Introduction: Surgical Site Infections (SSI) are serious postoperative complications with significant impact on morbidity and mortality ranging from wound discharge associated with superficial skin infection to life-threatening conditions such as severe sepsis. In developed countries, guidelines for preventing SSI have been widely adopted. These evidence-based measures to prevent SSI are usually called ‘care bundles’, and multiple studies have confirmed that bundle compliance is associated with a significant reduction in the risk of SSI. Aim: To evaluate the efficacy of bundle interventions in reducing SSI rate and readmission rate due to SSI. Materials and Methods: Present study was a retrospective, observational, case-control study conducted on records of 82 patients who underwent primary surgery for elective open lower gastrointestinal surgeries between January 2019-February 2020. Patients were divided into care bundle group (cases) from the concerned unit and non care bundle group (controls) from the other units of the General Surgery Department. Clinical data was obtained from the Medical Records Department and case sheets retrieved. The primary outcome was to measure the rate of superficial SSIs. Secondary outcomes included deep and organ space SSIs, wound dehiscence, postoperative sepsis, length of stay & 30-day readmission was measured. Statistical analysis were performed with Statistical Package for Social Sciences (SPSS) version 20.0. Results: In present study, total 82 patients undergoing lower gastrointestinal surgeries were included. SSI was noted in 10% from cases group and 21.4% from control group. Significant SSIs (p-value <0.001) were noted in control group. Patients with SSIs from cases group required significantly less treatment with antibiotics and daily dressing (p-value <0.001). One patient from control group required re-exploratory laparotomy for organ space SSI. In surgeries lasting for more than 120 minutes, SSI in cases group patients (5%) were less than control group (14%) and difference was statistically significant. (p-value=0.016). About 9.5% of control group patients requried readmission. Conclusion: Multimodal bundle approach for SSI prevention is an innovative way to reduce SSI burden among patients undergoing lower gastrointestinal surgeries. Simple preoperative, operative & postoperative interventions can bring down SSI incidence significantly.

Keywords

• bundle intervention
• infection prevention
• nosocomial infection
• organ space surgical site infection
• wound dehiscence