ArticlePloS one2013
Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 77 citations in OpenAlex.
- Effect of the number of door openings in the operating room on surgical site infections: individual-patient data meta-analysis.BJS open · 2025Pooled it
- Trial
- Article
- Healthcare professionals' experiences of being observed regarding hygiene routines: the Hawthorne effect in vascular surgery.BMC infectious diseases · 2021Article
- Article
- The Association of Climatic Factors with Rates of Surgical Site Infections: 17 Years' Data From Hospital Infection Surveillance.Deutsches Arzteblatt international · 2019Article
- Adhering to a national surgical care bundle reduces the risk of surgical site infections.PloS one · 2017Article
- Novel closing method using subcutaneous continuous drain for preventing surgical site infections in radical cystectomy.ISRN urology · 2014Article
- Compliance With a Comprehensive Antibiotic Protocol Improves Infection Incidence in Pediatric Spine Surgery.Journal of pediatric orthopedicsArticle
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSurgical site infections (SSI's) are associated with severe morbidity, mortality and increased health care costs in vascular surgery.
objectiveTo implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates.
designProspective, quasi-experimental, cohort study.
methodsA prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP) was introduced in 2009. The elements of the bundle were (1) perioperative normothermia, (2) hair removal before surgery, (3) the use of perioperative antibiotic prophylaxis and (4) discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback.
resultsBundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4%) SSI were observed. Deep SSI occurred in 25 (3.5%) patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001) and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001) had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63). Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009.
conclusionThe implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing vascular surgery.
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