Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery,” PLoS

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 (28,5629.3 vs 10.8611.3, p,0.001) and deep-SSI’s (48.3639.4 vs 11.4611.8, 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). Multivariat