Implementation of a perioperative surgical site infection prevention bundle may reduce the rate of surgical site infection among patients undergoing hysterectomy, according to a study published online May 7 in Obstetrics & Gynecology.

Sarah E. Andiman, M.D., from the Yale School of Medicine in New Haven, Conn., and colleagues conducted a quality improvement study featuring a retrospective analysis of a prospectively implemented, multidisciplinary team-designed surgical site infection prevention bundle.

"We implemented a hysterectomy-specific surgical site infection prevention bundle after a higher-than-expected surgical site infection rate was identified at our institution. We evaluate how this bundle affected the surgical site infection rate, length of hospital stay, and 30-day postoperative readmission rate," noted Andiman.

The bundle included the use of chlorhexidine-impregnated preoperative wipes, standardized aseptic surgical preparation, standardized antibiotic dosing, perioperative normothermia, and surgical dressing maintenance; when the protocol was breached, direct feedback was provided to clinicians.

The result of the study

During the 33-month study period, 2,099 hysterectomies were completed. The researchers found that there were 61 and 14 surgical site infections in the pre-full bundle implementation period and post-full bundle implementation period (4.51 and 1.87%, respectively).

During the last eight months of the study period, there was a sustained reduction in the proportion of patients experiencing surgical site infection. Patients who underwent surgery after full implementation were significantly less likely to develop a surgical site infection than those undergoing surgery before full implementation, after adjustment for clinical characteristics (adjusted odds ratio, 0.46).

"We found a sustained reduction in the proportion of patients experiencing surgical site infection during the last 8 months of the study period," noted Andiman. After adjusting for clinical characteristics, patients who underwent surgery after full implementation were less likely to develop a surgical site infection (adjusted odds ratio [OR] 0.46, P=.01) than those undergoing surgery before full implementation.

Multivariable regression analysis showed no statistically significant difference in postoperative days of hospital stay (adjusted mean ratio 0.95, P=.09) or rate of readmission for surgical site infection-specific indication (adjusted OR 2.65, P=.08) between the before and after full-bundle implementation periods.

"The multidisciplinary implementation of a gynecologic perioperative surgical site infection prevention bundle was associated with a significant reduction in surgical site infection rate in patients undergoing hysterectomy," the authors write.

One author disclosed financial ties to 3M, which markets patient warming devices, and other companies in the healthcare industry. The multidisciplinary implementation of a gynecologic perioperative surgical site infection prevention bundle was associated with a significant reduction in surgical site infection rate in patients undergoing a hysterectomy.