A Systematic Review Of Care Bundles In Surgery For The Prevention Of Surgical Site Infections
Surgical site infection (SSI) accounts for the most common worldwide hospital-acquired infection together with pneumonia. It increases morbidity and mortality and has a great impact on health care costs.
Systemic antibiotic prophylaxis decreased SSI rates but we are still far from reducing it to zero.
SSI bundle prevention, a group of interventions given all together to all patients at the same time in the perioperative setting, is analyzed by Dr. Boldingh and her team. Randomized controlled trials (RCTs) and observational studies regarding this kind of intervention in colorectal, cardiothoracic and other abdominal surgeries were included in this review. The number of intervention bundles ranged between 3 and 23, accounting for 64 different interventions.
Preventive interventions can be divided into two large groups. Prevention measures focus on the patient, whereas care processes include technical aspects. Dr. Boldingh describes the 5 most frequently reported interventions.
The use of hair clippers rather than razors, normothermia, changing gloves and gowns after an anastomosis, pre-operative bathing and skin preparation with chlorhexidine in alcohol are the most reported interventions, even though the 2016 WHO report made strong recommendations only for the first and the last interventions, and no RCTs have proven their effect.
The use of a bundle for SSI prevention was found to be useful in the meta-analysis of 24 cohort studies, but there is uncertainty regarding the optimal bundle to be used.