A colorectal "care bundle" to reduce surgical site infections in colorectal surgeries: a single-center experience

Perm J. Summer 2012;16(3):10-6.


Background: Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) since January 2006. Data on general and colorectal surgical site infections (SSIs) demonstrated a need for improvement in SSI rates.

Objective: To evaluate application of a "care bundle" for patients undergoing colorectal operations, with the goal of reducing overall SSI rates.

Methods: We prospectively implemented multiple interventions, with retrospective analysis of data using the NSQIP database. The overall, superficial, deep, and organ/space SSI rates were compared before and after implementation of this colorectal care bundle.

Results: Between January 2006 and December 2009, there were 430 colorectal cases in our NSQIP report with 91 infections, an overall rate of 21.16%. Between January 2010, when the colorectal care bundle was implemented, and June 2011, there were 195 cases and 13 infections, a 6.67% overall rate. The absolute decrease of 14.49% is significant (p < 0.0001). The rate of superficial SSI decreased from 15.12% to 3.59% (p < 0.0001). The rates for deep and organ/space SSI also showed a decrease; however, this was not statistically significant. The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation (fiscal year 2010).

Conclusions: Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases. By instituting a care bundle composed of core and adjunct strategies, we significantly decreased our rate of colorectal SSIs.

MeSH terms

  • Colorectal Surgery / adverse effects
  • Colorectal Surgery / standards*
  • Hospitals*
  • Humans
  • Intestinal Diseases / complications*
  • Intestinal Diseases / epidemiology
  • Quality Improvement*
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control*