EP361 - Rise And Fall Of Colon Surgical Site Infections – Colon Surgical Site Infection Care Bundle In The Community Hospital Setting

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Purpose/Background: Colon and rectal surgery has one of the highest surgical site infection (SSI) rates with >600,000 operations performed annually. The Joint Commission and American College of Surgery have identified a baseline infection rate in this category of 15.8% amongst major health institutions. Over 30,000 infections in this category are felt to be preventable, which translates to an economic interest of $834 million. Preventing SSIs is a quality metric that is capable of decreasing unnecessary spending within the health care system and improving patient outcomes by decreasing length of stay, readmissions, and mortality. Our high-volume community hospital identified an elevated rate of colon SSIs in our acute care, trauma, and colorectal services. SSI prevention bundles were not standard of care at our institution and compliance was fragmented. We adopted and implemented this practice across surgical specialties in an effort to reduce our number of SSIs.

Methods/Interventions: In an effort to improve compliance, a grand rounds session was held for surgeons, residents, and advanced practice clinicians. Changes made to nursing documentation ensured that wound classification was captured at the conclusion of an operation. Operating room nursing teams were educated on documentation and bundle components. Pharmacy reviewed antibiotic selection and options for different surgical specialties. In April 2024, online Colorectal SSI bundle education was disseminated to 120 caregivers in order to further convey its importance.

The pre-operative bundle included a mechanical and chemical (Neomycin 1g/Flagyl 1g TID prior to surgery) bowel preparation and a chlorhexidine skin wipe. Intra-operatively, we used chlorhexidine skin scrub, a wound protector, and utilization of clean closure practices prior to fascia closure; clean instruments, operative members changed gowns/gloves and re-draped. Post-operatively, education was provided on appropriate operative report verbiage. This ensured accurate communication of operative findings and highlighted infections that were present at the time of operation to identify SSIs that were expected due to patient presentation

Results/Outcomes: Our institution demonstrated a significant reduction in colon surgery SSIs after education of our colon bundle and utilization of pre and postoperative order sets. The clean closure tray compliance increased from 43% to greater than 86% after education. This is felt to have played a strong role in our SSI prevention. After identifying an institution maximum of 7 SSIs in one month, we demonstrated 5 consecutive months with 2 or less SSIs, followed by 2 consecutive months with 0 SSIs, after bundle implementation.

Conclusion/Discussion: Preventing SSIs is a quality metric that can decrease spending within the health care systems and improve patient outcomes. Implementing and educating on the effectiveness of a colon SSI care bundle has greatly decreased our number of infections. This translates to saving of approximately $25k for each patient without an infection, and nearly $1.5 million on annual quality reimbursements.