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Leveraging a Comprehensive Program to Implement a Colorectal Surgical Site Infection Reduction Bundle in a Statewide Quality Improvement Collaborative

McGee, Michael F. MD*,†,⊠; Kreutzer, Lindsey MPH*,†; Quinn, Christopher M. MS*,†; Yang, Anthony MD*,†; Shan, Ying MS*,†; Halverson, Amy L. MD*,†; Love, Remi BS*,†; Johnson, Julie K. MSPH, PhD*,†,‡; Prachand, Vivek MD*,§; Bilimoria, Karl Y. MD, MS*,†,‡ on behalf of the Illinois Surgical Quality Improvement Collaborative (ISQIC)

doi: 10.1097/SLA.0000000000003524

Objectives: Our objective was to examine the implementation and associated clinical outcomes of a comprehensive surgical site infection (SSI) reduction bundle in a large statewide surgical quality improvement collaborative leveraging a multifaceted implementation strategy.

Summary Background Data: Bundled perioperative interventions reduce colorectal SSI rates when enacted at individual hospitals, but the ability to implement comprehensive SSI bundles and to examine the resultant clinical effectiveness within a larger, diverse population of hospitals is unknown.

Methods: A multifaceted SSI reduction bundle was developed and implemented in a large statewide surgical quality improvement collaborative through a novel implementation program consisting of guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence and ACS NSQIP outcomes were examined preimplementation versus postimplementation.

Results: Among 32 hospitals, there was a 2.5-fold relative increase in the proportion of patients completing at least 75% of bundle elements (preimplementation = 19.5% vs. postimplementation = 49.8%, P = 0.001). Largest adherence gains were seen in wound closure re-gowning/re-gloving (24.0% vs. 62.0%, P < 0.001), use of clean closing instruments (32.1% vs. 66.2%, P = 0.003), and preoperative chlorhexidine bathing (46.1% vs. 77.6%, P < 0.001). Multivariable analyses showed a trend toward lower risk of superficial incisional SSI in the postimplementation period compared to baseline (OR 0.70, 95% CI 0.49–10.2, P = 0.06). As the adherence in the number of bundle elements increased, there was a significant decrease in superficial SSI rates (lowest adherence quintile, 4.6% vs. highest, 1.5%, P < 0.001).

Conclusions: A comprehensive multifaceted SSI reduction bundle can be successfully implemented throughout a large quality improvement learning collaborative when coordinated quality improvement activities are leveraged, resulting in a 30% decline in SSI rates. Lower superficial SSI rates are associated with the number of adherent bundle elements a patient receives, rendering considerable benefits to institutions capable of implementing more components of the bundle.

*Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago, IL

Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL

§Department of Surgery, University of Chicago, Chicago, IL.

This work is supported by the Agency for Healthcare Research and Quality (R01HS024516 [PI: K.Y.B.]), National Institutes of Health (K08HL145139 [PI: A.Y.]), and the Health Care Services Corporation/Blue Cross Blue Shield of Illinois (PI: K.Y.B.).

This work was presented at the American Surgical Association Annual Meeting in Dallas, TX on April 13, 2019.

The authors report no conflicts of interest.

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