Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.
BACKGROUND: Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, q...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3742500?pdf=render |
| _version_ | 1818300946236571648 |
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| author | Jasper van der Slegt Lijckle van der Laan Eelco J Veen Yvonne Hendriks Jannie Romme Jan Kluytmans |
| author_facet | Jasper van der Slegt Lijckle van der Laan Eelco J Veen Yvonne Hendriks Jannie Romme Jan Kluytmans |
| author_sort | Jasper van der Slegt |
| collection | DOAJ |
| description | BACKGROUND: Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: 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. RESULTS: 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<0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<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. CONCLUSION: 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. |
| first_indexed | 2024-12-13T05:15:11Z |
| format | Article |
| id | doaj.art-20fc4a07f44c49aea5b4be570b6c7f5c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-13T05:15:11Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-20fc4a07f44c49aea5b4be570b6c7f5c2022-12-21T23:58:26ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0188e7156610.1371/journal.pone.0071566Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.Jasper van der SlegtLijckle van der LaanEelco J VeenYvonne HendriksJannie RommeJan KluytmansBACKGROUND: Surgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: 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. RESULTS: 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<0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<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. CONCLUSION: 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.http://europepmc.org/articles/PMC3742500?pdf=render |
| spellingShingle | Jasper van der Slegt Lijckle van der Laan Eelco J Veen Yvonne Hendriks Jannie Romme Jan Kluytmans Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. PLoS ONE |
| title | Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. |
| title_full | Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. |
| title_fullStr | Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. |
| title_full_unstemmed | Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. |
| title_short | Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. |
| title_sort | implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery |
| url | http://europepmc.org/articles/PMC3742500?pdf=render |
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