Surgical Site Infection Reduction in Colorectal Surgery

Surgical site infections (SSIs) are the most common hospital-acquired infection and often result in prolonged hospital stays, increased cost and a higher risk of postoperative mortality. It is estimated that 60% of all SSIs can be prevented with implementation of evidence-based guidelines. The National Health and Safety Network (NHSN) requires all acute care hospitals to complete surveillance and report all incidents of SSI in colorectal surgeries as part of its patient safety monthly reporting plan.

In early 2021, infection prevention identified a sharp increase in surgical site infections involving colorectal surgeries. There were zero colon surgical site infections reported for 2020 until two cases were identified in December. This was followed by an additional four cases identified in the first quarter of 2021. Infection prevention immediately began thorough investigations into each of the cases, collaborating with the surgical services team at MMC-Weston. Additionally, infection prevention conducted direct operating room observations and made SSI the focus of the infection prevention committee meetings for the next several months. 

At the time, there was no formal colon SSI prevention bundle in place. Marshfield Clinic Health System has a robust quality and safety team. A system initiative named the Colon Premier Care Project had been initiated in 2019; however, full implementation of the project was put on hold due to the COVID-19 pandemic. Infection prevention (IP) reached out to quality team members and gathered information on the elements involved in the Colon Premier Care Project and presented the information to the infection prevention committee. A small work group met to compare elements of the bundle to current practice. Several areas were identified as opportunities to improve upon, including adherence to a closing protocol, consistent nasal decolonization, consistent use of chlorhexidine gluconate bathing prior to surgery and re-dosing of preoperative antibiotics. After implementation, these measures were tracked during routine IP active surveillance for compliance. 

After March 2021, there are zero SSI colon infection cases. IP continues to conduct active surveillance on all colon cases performed at MMC-Weston and present outcomes to the infection prevention committee on a regular basis.