Implementation of colon surgical site infection prevention bundle - the successes and challenges.

BACKGROUND: Surgical site infection (SSI) prevention bundles have proven successful in decreasing infections. Surgeon and nurse engagement and endorsement are essential for success. The objective of this quality improvement project was to develop, implement and sustain a colon SSI prevention bundle and determine which bundle components are most strongly associated with prevention of SSI. METHODS: The bundle was developed and implemented in a 525 bed Level I trauma hospital and included pre-, intra- and post-operative components. Bundle adherence and SSI rate were continually tracked and communicated to surgeons and nursing staff throughout project. Univariate and multivariate analyses were performed to determine the components associated with lowest SSI rates. RESULTS: There were 280 elective and urgent/emergent colon surgeries between October 2015 and March 2018. Over 60% had pre-operative components, 76.5% had intra-operative components and 55.6% had post-operative bundle components with a non-significant decreasing trend in SSI rate of -0.5 SSI/100 procedures per quarter. The multivariate analysis suggested that use of 2% chlorhexidine gluconate/70% alcohol skin prep, use of wound protector and change of gloves for fascial closure were associated with fewer SSI. DISCUSSION: The implementation of a colon SSI prevention bundle in a Level I trauma hospital with pre-, intra- and post-operative components was described. Future directions include focusing implementation efforts on bundle components that significantly prevent SSI to improve adherence.