ArticlePloS one2017
Adhering to a national surgical care bundle reduces the risk of surgical site infections.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 63 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
- Interventions to prevent surgical site infection in adults undergoing cardiac surgery.The Cochrane database of systematic reviews · 2024Pooled it
- Cluster-randomized crossover trial of chlorhexidine-alcoholBJS open · 2019Trial
- Bar-Related Infections After Minimally Invasive Repair of Pectus Excavatum: A 25-Year Single-Center Retrospective Cohort Study.European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie · 2026Article
- Machine Learning-Enhanced Surveillance for Surgical Site Infections in Patients Undergoing Colon Surgery: Model Development and Evaluation Study.JMIR formative research · 2025Article
- Adequacy and implications of antimicrobial prophylaxis for elective surgeries in a tertiary hospital: a cross sectional and retrospective cohort study (ADEQUAP).Antimicrobial resistance and infection control · 2025Article
- The Impact of COVID-19 on Healthcare Services, Risk Management, and Infection Prevention in Surgical Settings: A Qualitative Study.Healthcare (Basel, Switzerland) · 2025Article
- Effect of Standardized Bundle Care and Bundle Compliance on Reducing Surgical Site Infections: A Pragmatic Retrospective Cohort Study.Medical science monitor : international medical journal of experimental and clinical research · 2024Article
- Examining barriers to implementing a surgical-site infection bundle.Infection control and hospital epidemiology · 2024Article
- Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals.Antimicrobial resistance and infection control · 2023Article
- Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update.Infection control and hospital epidemiology · 2023Article
- Infection prevention plan to decrease surgical site infections in bariatric surgery patients.Surgical endoscopy · 2022Article
- The real-time remote testing and programming of cardiac implantable electronic devices: A case series report.Frontiers in cardiovascular medicine · 2022Article
- Analysis of Italian requests for compensation in cases of responsibility for healthcare-related infections: A retrospective study.Frontiers in public health · 2022Article
- Using the WHO safe childbirth checklist to improve essential care delivery as part of the district-wide maternal and newborn health quality improvement initiative, a time series study.BMC health services research · 2021Article
- High Compliance With Surgical Site Infection (SSI) Prevention Bundle Reduces Incisional SSI After Colorectal Surgery.Annals of coloproctology · 2021Article
- Barriers and Facilitators in Perioperative Antibiotic Prophylaxis: A Mixed-Methods Study in a Small Island Setting.Antibiotics (Basel, Switzerland) · 2021Article
- Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia-Pacific Region.Antimicrobial resistance and infection control · 2021Article
- Are three antiseptic paints needed for safe preparation of the surgical field? A prospective cohort study with 239 patients.Antimicrobial resistance and infection control · 2020Article
- Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses.International journal of qualitative studies on health and well-being · 2019Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and 'hygiene discipline' in the operating room (i.e. number of door movements). Dutch hospitals were advised to implement the bundle and to measure the outcome. This study's goal was to assess how effective the bundle was in reducing SSI risk.
methodsHospitals assessed whether their staff complied with each of the bundle elements and voluntary reported compliance data to the national SSI surveillance network (PREZIES). From PREZIES data, we selected data from 2009 to 2014 relating to 13 types of surgical procedures. We excluded surgeries with missing (non)compliance data, and calculated for each remaining surgery with reported (non)compliance data the level of compliance with the bundle (that is, being compliant with 0, 1, 2, 3, or 4 of the elements). Subsequently, we used this level of compliance to assess the effect of bundle compliance on the SSI risk, using multilevel logistic regression techniques.
results217 489 surgeries were included, of which 62 486 surgeries (29%) had complete bundle reporting. Within this group, the SSI risk was significantly lower for surgeries with complete bundle compliance compared to surgeries with lower compliance levels. Odds ratios ranged from 0.63 to 0.86 (risk reduction of 14% to 37%), while a 13% risk reduction was demonstrated for each point increase in compliance-level. Sensitivity analysis indicated that due to analysing reported bundles only, we probably underestimated the total effect of implementing the bundle.
conclusionsThis study demonstrated that adhering to a surgical care bundle significantly reduced the risk of SSIs. Reporting of and compliance with the bundle compliance can, however, still be improved. Therefore an even greater effect might be achieved.
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