Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt
Mona Wassef,1 Ahmed Mukhtar,2 Ahmed Nabil,3 Moushira Ezzelarab,1 Doaa Ghaith1 1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of General...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-01-01
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| Series: | Infection and Drug Resistance |
| Subjects: | |
| Online Access: | https://www.dovepress.com/care-bundle-approach-to-reduce-surgical-site-infections-in-acute-surgi-peer-reviewed-article-IDR |
| _version_ | 1819115496235073536 |
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| author | Wassef M Mukhtar A Nabil A Ezzelarab M Ghaith D |
| author_facet | Wassef M Mukhtar A Nabil A Ezzelarab M Ghaith D |
| author_sort | Wassef M |
| collection | DOAJ |
| description | Mona Wassef,1 Ahmed Mukhtar,2 Ahmed Nabil,3 Moushira Ezzelarab,1 Doaa Ghaith1 1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Doaa GhaithDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, 1st Al-Saray Street, Al-Manial, Cairo 11559, EgyptTel +20 100 1857775Email doaa.ghaith@kasralainy.edu.egIntroduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance.Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University.Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection.Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p< 0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd’s ratio (OR’s ratio = 0.3) confidence interval (95% CI 0.14– 0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%).Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.Keywords: colonization, OXA 48, MDR- Acinetobacter, ICU |
| first_indexed | 2024-12-22T05:02:07Z |
| format | Article |
| id | doaj.art-5d2bebaa94b2424eba47e16de5cb1848 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-12-22T05:02:07Z |
| publishDate | 2020-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-5d2bebaa94b2424eba47e16de5cb18482022-12-21T18:38:12ZengDove Medical PressInfection and Drug Resistance1178-69732020-01-01Volume 1322923651418Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, EgyptWassef MMukhtar ANabil AEzzelarab MGhaith DMona Wassef,1 Ahmed Mukhtar,2 Ahmed Nabil,3 Moushira Ezzelarab,1 Doaa Ghaith1 1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Doaa GhaithDepartment of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, 1st Al-Saray Street, Al-Manial, Cairo 11559, EgyptTel +20 100 1857775Email doaa.ghaith@kasralainy.edu.egIntroduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance.Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University.Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection.Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p< 0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd’s ratio (OR’s ratio = 0.3) confidence interval (95% CI 0.14– 0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%).Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.Keywords: colonization, OXA 48, MDR- Acinetobacter, ICUhttps://www.dovepress.com/care-bundle-approach-to-reduce-surgical-site-infections-in-acute-surgi-peer-reviewed-article-IDRcolonizationoxa 48mdr- acinetobactericu |
| spellingShingle | Wassef M Mukhtar A Nabil A Ezzelarab M Ghaith D Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt Infection and Drug Resistance colonization oxa 48 mdr- acinetobacter icu |
| title | Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt |
| title_full | Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt |
| title_fullStr | Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt |
| title_full_unstemmed | Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt |
| title_short | Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt |
| title_sort | care bundle approach to reduce surgical site infections in acute surgical intensive care unit cairo egypt |
| topic | colonization oxa 48 mdr- acinetobacter icu |
| url | https://www.dovepress.com/care-bundle-approach-to-reduce-surgical-site-infections-in-acute-surgi-peer-reviewed-article-IDR |
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