Single-institutional experience with the surgical infection prevention project in intra-abdominal surgery

Surg Infect (Larchmt). 2007 Aug;8(4):425-35. doi: 10.1089/sur.2006.043.


Background: The incidence of surgical site infection (SSI) is becoming a key component of standard measures of quality of performance. We hypothesized that institutional implementation of a protocol targeting known risk factors would reduce the incidence of SSI associated with intra-abdominal surgery.

Methods: Beginning in June 2004, a quality control initiative was implemented to prevent SSI in patients undergoing intra-abdominal surgical procedures at an academic medical center. This protocol included administration of the proper prophylactic antibiotic 0-60 minutes before incision, continued antibiotic administration for <or=24 hours, and maintenance of intraoperative normothermia (>or=36 degrees C), along with good glycemic control (goal<200 mg/dL 48 h postoperatively) in diabetic patients. Baseline data collected during the initial four months of protocol development (379 patients) were compared with data collected during the last four months of the 11-month study period (390 patients).

Results: Compliance with antibiotic selection increased from 89 percent to 97 percent (p <or= 0.05). Compliance with timeliness of administration improved from 89 percent to 97 percent (p <or= 0.05), whereas cessation of perioperative antibiotics within 24 hours remained constant at 93 and 92 percent, respectively. The incidence of hypothermia fell from 15 percent to 10 percent (p = 0.27). The 30-day incidence of SSI improved from 9.2 percent to 5.6 percent (p = 0.07).

Conclusion: The implementation of a prevention protocol resulted in a substantial trend toward a reduction in the incidence of SSI. These data support the use of protocol implementation as a cost-effective method of reducing perioperative infectious morbidity associated with intra-abdominal surgery.

Publication types

  • Evaluation Study

MeSH terms

  • Academic Medical Centers
  • Antibiotic Prophylaxis / methods
  • Cross Infection / prevention & control*
  • Diabetes Mellitus
  • Digestive System Surgical Procedures / adverse effects*
  • Female
  • Guideline Adherence
  • Humans
  • Hyperglycemia / prevention & control
  • Hypothermia / prevention & control
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality Assurance, Health Care / methods*
  • Quality Indicators, Health Care
  • Risk Factors
  • Surgical Wound Infection / prevention & control*