14: Perioperative bundles and timely feedback for surgical site infection prevention in hysterectomy: An institutional experience

Abstract

OBJECTIVES: Surgical site infections (SSI) are a major cause of both morbidity and increased hospital costs. The objective of this study is to determine the efficacy of a perioperative gynecology bundle designed to reduce the rates of SSI in hysterectomies. MATERIALS AND METHODS: A single institution retrospective chart review examining SSI rate in hysterectomies after the institution of a 6-point gynecological perioperative infection prevention bundle. The bundle consisted of chlorhexidine pre-operative wipes, pre-operative warming, intra-operative maintenance of normothermia, standardization of surgical preparation technique, implementation of an institution-specific antibiotic dosing protocol and surgical dressing maintenance. The antibiotic protocol consisted of administration of 2 grams cefazolin (3 grams if weight >120 kilograms) one hour or less prior to incision, re-dosing at three hours or for blood loss of greater than or equal to 1.5 liters and addition of pre-operative metronidazole for any case with possible bowel involvement. The implementation of the bundle was overseen by an interdisciplinary team consisting of gynecology, anesthesiology, hospital epidemiology infection control staff, and perioperative nursing. Perioperative staff were educated on protocol implementation and data collection in the electronic medical record. The team reviewed electronic medical record reports on a monthly basis and investigated deviations from the protocol providing those involved with prompt feedback of findings. SSI rates were reviewed from January 1, 2012, through June 30, 2015, with the primary outcome being the SSI rate pre and post bundle implementation. The secondary outcome examined was cost per surgical episode. RESULT(S): During the 42-month period, 2739 hysterectomies were completed with a net reduction in SSI rate following the implementation of the gynecological perioperative bundle of 41%. The net cost savings per open case was 11.97% while the net cost saving per laparoscopic (including robotic) case was 5.49%. The total cost savings per case was 4.00%. CONCLUSION(S): The implementation of a gynecological perioperative infection prevention bundle with timely feedback to frontline staff is associated with a significant reduction in SSI rate after hysterectomy, leading to reduced morbidity and hospital costs. Further studies are needed to further analyze the most effective aspects of the bundle in terms of reducing SSI and to further assess cost savings by type of hysterectomy performed and areas where cost saving is greatest.