Outcome of a Strategy To Reduce Surgical Site Infection in a Tertiary-Care Hospital

Background: Surgical site infection (SSI) is a preventable complication. Achieving a zero SSI rate for all clean operations should be the goal of all surgeons. Aim: We aimed to reduce our SSI rate by 50% for patients undergoing elective gastrointestinal and hernia operations. Methods: The study was conducted in a tertiary-care hospital department of surgery from January 2006 to December 2007 for all clean and clean-contaminated elective gastrointestinal and hernia operations. Four interventions targeted at reducing SSI were implemented in January 2006: Use of clippers instead of shavers for surgical site hair removal; standardized prophylactic antibiotic regimen and antibiotic administration within 30 min before incision; standardized glucose monitoring for diabetics; and maintenance of postoperative normothermia. Prospective data were collected and compared with historical data from January to December 2005. Results: A total of 2,408 patients underwent elective gastrointestinal and hernia operations from January 2006 to December 2007. After implementation, we were able to achieve 91%, 87%, 89%, and 76% overall compliance with the respective interventions, but postoperative normothermia was achieved in only 44% of our patients. With the bundle of interventions, our overall SSI rate was reduced from 3.1% to 0.5% (p < 0.001), an 84% reduction within two years. The incidence of SSI was 1.7% in colorectal operations, 1.2% in upper gastrointestinal operations, 0.3% in hepatopancreaticobiliary operations, and zero in inguinal and ventral hernia operations. The estimated cost saving for both the patients and the hospital was S$208,562 (US$147,967). Conclusions: Surgical site infections could be reduced with the bundle of interventions. With these encouraging results, the good practices should be sustained and promulgated. Such a SSI prevention program must be embedded in the work processes for all surgical disciplines.