Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the...

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Main Authors: Tanner, Judith, Kiernan, Martin, Hilliam, R., Davey, S., Collins, E., Wood, T., Ball, J., Leaper, David
Format: Article
Published: Royal College of Surgeons of England 2016
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Online Access:https://eprints.nottingham.ac.uk/50774/
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author Tanner, Judith
Kiernan, Martin
Hilliam, R.
Davey, S.
Collins, E.
Wood, T.
Ball, J.
Leaper, David
author_facet Tanner, Judith
Kiernan, Martin
Hilliam, R.
Davey, S.
Collins, E.
Wood, T.
Ball, J.
Leaper, David
author_sort Tanner, Judith
building Nottingham Research Data Repository
collection Online Access
description Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs.
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spelling nottingham-507742020-05-04T17:44:28Z https://eprints.nottingham.ac.uk/50774/ Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery Tanner, Judith Kiernan, Martin Hilliam, R. Davey, S. Collins, E. Wood, T. Ball, J. Leaper, David Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs. Royal College of Surgeons of England 2016-04-30 Article PeerReviewed Tanner, Judith, Kiernan, Martin, Hilliam, R., Davey, S., Collins, E., Wood, T., Ball, J. and Leaper, David (2016) Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery. Annals of the Royal College of Surgeons of England, 98 (4). pp. 270-274. ISSN 1478-7083 Colorectal surgery; Surgical site infection; Care bundle; Compliance https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2016.0072 doi:10.1308/rcsann.2016.0072 doi:10.1308/rcsann.2016.0072
spellingShingle Colorectal surgery; Surgical site infection; Care bundle; Compliance
Tanner, Judith
Kiernan, Martin
Hilliam, R.
Davey, S.
Collins, E.
Wood, T.
Ball, J.
Leaper, David
Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title_full Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title_fullStr Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title_full_unstemmed Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title_short Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
title_sort effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery
topic Colorectal surgery; Surgical site infection; Care bundle; Compliance
url https://eprints.nottingham.ac.uk/50774/
https://eprints.nottingham.ac.uk/50774/
https://eprints.nottingham.ac.uk/50774/