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Decreased Surgical Site Infection Rate in Hysterectomy: Effect of a Gynecology-Specific Bundle

Andiman, Sarah, E., MD; Xu, Xiao, PhD; Boyce, John, M., MD; Ludwig, Elizabeth, M., BA; Rillstone, Heidi R., W., RN; Desai, Vrunda, B., MD; Fan, Linda, L., MD

doi: 10.1097/AOG.0000000000002594
Gynecology: Clinical Practice and Quality: PDF Only

OBJECTIVE: 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.

METHODS: This is a quality improvement study featuring retrospective analysis of a prospectively implemented, multidisciplinary team-designed surgical site infection prevention bundle that consisted of chlorhexidine-impregnated preoperative wipes, standardized aseptic surgical preparation, standardized antibiotic dosing, perioperative normothermia, surgical dressing maintenance, and direct feedback to clinicians when the protocol was breached.

RESULTS: There were 2,099 hysterectomies completed during the 33-month study period. There were 61 surgical site infections (4.51%) in the pre–full bundle implementation period and 14 (1.87%) in the post–full bundle implementation period; we found a sustained reduction in the proportion of patients experiencing surgical site infection during the last 8 months of the study period. 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.

CONCLUSION: 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.

Multidisciplinary implementation of a gynecologic perioperative infection prevention bundle is associated with a significant reduction in surgical site infection rate in patients undergoing hysterectomy.

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Hospital Epidemiology and Infection Control and Perioperative Services and Patient Safety, Yale New Haven Hospital, and Yale School of Medicine, New Haven, Connecticut.

Corresponding author: Linda L. Fan, MD, Department of Obstetrics, Gynecology and Reproductive Science, Yale School of Medicine, P.O. Box 208063, New Haven, CT 06520-8063; email:

Financial Disclosure Dr. Boyce has served as a consultant and scientific advisory board member to 3M, which markets patient warming devices. He does not consult for 3M on patient warming issues. He is also a consultant to, and received research and travel support from, Diversey Healthcare, GOJO Industries, PDI, and Sodexo. The other authors did not report any potential conflicts of interest.

Presented at the 42nd annual meeting of the Society of Gynecologic Surgeons, April 10–13, 2016, Palm Springs, California.

The authors thank the Surgical Site Infection Prevention Steering Committee, Ms. Linda Sullivan and Ms. Michelle N. Whitbread for their assistance with National Healthcare Safety Network data, and Dr. Matthew Grossman, Dr. Vinita Parkash, and Dr. Christian Pettker for their advice and guidance regarding quality improvement initiatives and manuscripts.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.