The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology
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Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.
Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014–30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015–15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle.
A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37–0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38–0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34–0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month.
This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.
KeywordsGynecologic Malignancy Personnel Cost Organ Space Infection Incisional SSIs Clinical Care Team
The authors would like to acknowledge the following people for their contributions to this initiative: Katherine E. Cain, PharmD; Lynn M. Cloutier, RN, MSN, ACNP-BC; Shauna L. Fenton, RN, MSN; Linda S. Graviss, MT (ASCP), CIC; Cheryl A. Hubbs, RN; Deepthi A. James, MSN, RN, FNP-C; Johnrich R. Levine, MSN, MHA, MPA, BSN, RN, PNE-C; Keith N. Myers, BS; Anne K. Park, MS, MPH; Deandra Sandles, RN, MSN, CNOR; Tara N. Tatum, RN, MBA; Shital Vachhani, MD; Kathy M. Ware, RN.
This research was supported in part by the National Institutes of Health (NIH) through MD Anderson Cancer Center’s Support Grant CA016672. Dr. Taylor’s work on this project was supported by an NIH T32 grant, Training of Academic Gynecologic Oncologists, from the National Cancer Institute (5T32-CA101642). The funding source had no direct role in preparing or reviewing this study nor this manuscript.
Larissa A. Meyer has received honoraria from TRM Oncology, and research funding from AstraZeneca. Kathleen M. Schemler has received research funding from Cepheid, and patents, royalties or other intellectual property from UpToDate. Jolyn S. Taylor, Claire A. Marten, Mark F. Munsell, Charlotte C. Sun, Kimberly A. Potts, Jennifer K. Burzawa, Alpa M. Nick, Keith Myers, Diane C. Bodurka, Thomas A. Aloia, Charles F. Levenback, David R. Lairson, and Kathleen M. Schmeler report no conflicts of interest.
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