Table 1:
SSI Reduction Bundle Element Adherence
| SSI Reduction Bundle Elements Total N=2,722 patients |
Component Adherence N (%) |
|---|---|
| Preoperative (outpatient) | |
| Oral antibiotics | 2,006 (73.7) |
| Mechanical bowel preparation | 2,005 (73.7) |
| Chlorhexidine skin cleansing day before surgery | 1,813 (66.6) |
| Chlorhexidine skin cleansing day of surgery | 2,214 (81.3) |
| Preoperative (inpatient) | |
| Timely initial administration of appropriate intravenous SSI antibiotic prophylaxisa | 2,527 (92.8) |
| Intraoperative (surgery) | |
| Timely intraoperative re-dosing of
appropriate SSI antibiotic prophylaxis |
2,227 (81.8) |
| First measured temperature on arrival to PACU is ≥36.0°C | 2,535 (93.1) |
| Intraoperative skin preparation with
chlorhexidine and alcohol-based solution(s) |
2,618 (96.2) |
| Impermeable wound protector utilization for all incisions | 1,820 (66.9) |
| Utilization of a dedicated clean wound
closure tray/instruments |
1,470 (54.0) |
| Gown and glove change for all scrubbed personnel prior to wound closure | 1,339 (49.2) |
| Re-draping prior to wound closure | 1,045 (38.4) |
| Sterile occlusive incisional wound dressing placed in operating room | 1,344 (49.4) |
| Postoperative (inpatient) | |
| Duration of intravenous antibiotic
prophylaxis is less than 24 hours |
2,565 (94.2) |
| Removal of original operating room
incisional dressing on postoperative day 2 |
895 (32.9) |
| Daily chlorhexidine incision cleansing after dressing removal until discharge (but not to exceed postoperative day 7) | 294 (10.8) |
SSI = Surgical site infection
PACU = Post-anesthesia care unit
Acceptable intravenous antibiotics were adapted from the 2013 clinical practice guidelines from the American Society of Health System Pharmacists, Infections Diseases Society of America, Surgical Infection Society, and Society for Healthcare Epidemiology and included:
1. Cefazolin + metronidazole
2. Cefoxitin
3. Cefotetan
4. Ampicillin-sulbactam
5. Ceftriaxone + metronidazole
6. Ertapenem
7. Clindamycin + gentamicin
8. Clindamycin + tobramycin
9. Clindamycin + aztreonam
10. Clindamycin + ciprofloxacin
11. Clindamycin + levofloxacin
12. Metronidazole + gentamicin
13. Metronidazole + tobramycin
14. Metronidazole + ciprofloxacin
15. Metronidazole + levofloxacin