Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery

Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. Prospective, quasi-experimental, cohort study...

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Published in:PloS one 2013-08, Vol.8 (8), p.e71566-e71566
Main Authors: van der Slegt, Jasper, van der Laan, Lijckle, Veen, Eelco J, Hendriks, Yvonne, Romme, Jannie, Kluytmans, Jan
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Analysis
Antibiotics
Biology
Bundling
Confidence intervals
Disease control
Female
Guideline Adherence
Hair
Hair removal
Health aspects
Health care
Health care costs
Hospital patients
Hospitals
Humans
Infection
Infections
Infectious diseases
Male
Medical laboratories
Medicine
Middle Aged
Morbidity
Mortality
Multivariate analysis
Patient safety
Patients
Preoperative Care - methods
Prevention
Prophylaxis
Prospective Studies
Risk Factors
Safety programs
Surgeons
Surgery
Surgical instruments
Surgical site infections
Surgical Wound Infection - prevention & control
Surgical Wound Infection - therapy
Surveillance
Vascular surgery
Vascular Surgical Procedures - adverse effects
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cited_by cdi_FETCH-LOGICAL-c692t-1133652bd58e98c8923a440c598de076df9fd6be6473909c05a77782d7cee8be3
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container_issue 8
container_start_page e71566
container_title PloS one
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creator van der Slegt, Jasper
van der Laan, Lijckle
Veen, Eelco J
Hendriks, Yvonne
Romme, Jannie
Kluytmans, Jan
description Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. Prospective, quasi-experimental, cohort study. A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p
doi_str_mv 10.1371/journal.pone.0071566
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To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. Prospective, quasi-experimental, cohort study. A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. 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To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. Prospective, quasi-experimental, cohort study. A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p&lt;0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p&lt;0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing vascular surgery.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23967222</pmid><doi>10.1371/journal.pone.0071566</doi><tpages>e71566</tpages><oa>free_for_read</oa></addata></record>
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1932-6203
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source PubMed (Medline); Publicly Available Content Database
subjects Aged
Aged, 80 and over
Analysis
Antibiotics
Biology
Bundling
Confidence intervals
Disease control
Female
Guideline Adherence
Hair
Hair removal
Health aspects
Health care
Health care costs
Hospital patients
Hospitals
Humans
Infection
Infections
Infectious diseases
Male
Medical laboratories
Medicine
Middle Aged
Morbidity
Mortality
Multivariate analysis
Patient safety
Patients
Preoperative Care - methods
Prevention
Prophylaxis
Prospective Studies
Risk Factors
Safety programs
Surgeons
Surgery
Surgical instruments
Surgical site infections
Surgical Wound Infection - prevention & control
Surgical Wound Infection - therapy
Surveillance
Vascular surgery
Vascular Surgical Procedures - adverse effects
title Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery
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