Jolyn S Taylor1, Claire A Marten2, Mark F Munsell3, Charlotte C Sun1, Kimberly A Potts4, Jennifer K Burzawa1, Alpa M Nick1, Larissa A Meyer1, Keith Myers1, Diane C Bodurka5, Thomas A Aloia6, Charles F Levenback1, David R Lairson7, Kathleen M Schmeler8. 1. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Department of Perioperative Services, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Clinical Education, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 6. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Management and Policy Sciences, The University of Texas School of Public Health, Houston, TX, USA. 8. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. KSchmele@mdanderson.org.
Abstract
BACKGROUND: Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery. METHODS: Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014-30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015-15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle. RESULTS: A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37-0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38-0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34-0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month. CONCLUSIONS: This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.
BACKGROUND: Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery. METHODS: Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014-30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015-15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle. RESULTS: A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37-0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38-0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34-0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month. CONCLUSIONS: This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.
Authors: Thomas Anthony; Bryce W Murray; John T Sum-Ping; Fima Lenkovsky; Vadim D Vornik; Betty J Parker; Jackie E McFarlin; Kathleen Hartless; Sergio Huerta Journal: Arch Surg Date: 2010-11-15
Authors: Gregory de Lissovoy; Kathy Fraeman; Valerie Hutchins; Denise Murphy; David Song; Brian B Vaughn Journal: Am J Infect Control Date: 2009-04-23 Impact factor: 2.918
Authors: Dale W Bratzler; E Patchen Dellinger; Keith M Olsen; Trish M Perl; Paul G Auwaerter; Maureen K Bolon; Douglas N Fish; Lena M Napolitano; Robert G Sawyer; Douglas Slain; James P Steinberg; Robert A Weinstein Journal: Am J Health Syst Pharm Date: 2013-02-01 Impact factor: 2.637
Authors: Lauren S Prescott; Jolyn S Taylor; Ahmed Enbaya; Claire A Marten; Keith N Myers; Larissa A Meyer; Pedro T Ramirez; Charles F Levenback; Diane C Bodurka; Kathleen M Schmeler Journal: Gynecol Oncol Date: 2019-03-11 Impact factor: 5.482
Authors: Ross Harrison; Maria D Iniesta; Brandelyn Pitcher; Pedro T Ramirez; Katherine Cain; Ashley M Siverand; Gabriel Mena; Javier Lasala; Larissa A Meyer Journal: Int J Gynecol Cancer Date: 2020-08-26 Impact factor: 3.437
Authors: K Morikane; P L Russo; K Y Lee; M Chakravarthy; M L Ling; E Saguil; M Spencer; W Danker; A Seno; E Edmiston Charles Journal: Antimicrob Resist Infect Control Date: 2021-04-01 Impact factor: 4.887