A comprehensive unit-based safety program for the reduction of surgical site infections in plastic surgery and hand surgery.
- Lenherr Ramos L Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.
- Weber R Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.
- Sax H Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.
- Giovanoli P Department of Plastic Surgery and Hand Surgery, University Hospital and University of Zurich, Zurich, Switzerland.
- Kuster SP Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.
- 2019-10-15
Published in:
- Infection control and hospital epidemiology. - 2019
Adult
Aged
Female
Guideline Adherence
Hand
Hospitals, University
Humans
Infection Control
Male
Middle Aged
Patient Care Bundles
Prospective Studies
Risk Factors
Safety Management
Surgery, Plastic
Surgical Wound Infection
English
OBJECTIVE
To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery.
DESIGN
Uncontrolled before-and-after study.
SETTING
Department of plastic surgery and hand surgery of a tertiary-care teaching hospital.
PATIENTS
Patients undergoing surgery between January 2016 and April 2018.
INTERVENTION
A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis.
RESULTS
Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%-65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31-5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed.
CONCLUSIONS
This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.
To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery.
DESIGN
Uncontrolled before-and-after study.
SETTING
Department of plastic surgery and hand surgery of a tertiary-care teaching hospital.
PATIENTS
Patients undergoing surgery between January 2016 and April 2018.
INTERVENTION
A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis.
RESULTS
Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%-65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31-5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed.
CONCLUSIONS
This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1017/ice.2019.279
- PMID 31607274
- Persistent URL
- https://sonar.ch/global/documents/298730
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