Evaluating an Evidence-Based Bundle for Preventing Surgical Site Infection: A Randomized Trial | Colorectal Surgery | JAMA Surgery | JAMA Network
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Original Article
March 21, 2011

Evaluating an Evidence-Based Bundle for Preventing Surgical Site Infection: A Randomized Trial

Author Affiliations

Author Affiliations: Veterans Affairs North Texas Health Care System (Drs Anthony, Murray, Sum-Ping, Lenkovsky, Vornik, and Huerta, and Mss Parker, McFarlin, and Hartless), and the University of Texas Southwestern Medical School (Drs Anthony, Murray, Sum-Ping, Lenkovsky, Vornik, and Huerta), Dallas Texas.

Arch Surg. 2011;146(3):263-269. doi:10.1001/archsurg.2010.249

Surgical site infections (SSIs) are among the most common postoperative complications in patients who have colorectal operations. The occurrence of an SSI results in reduced quality of life, increased hospital length of stay, increased likelihood of mortality, and markedly increased cost.1-4 Therefore, identifying and implementing evidence-based strategies designed to minimize SSI is an important clinical goal. Prior research has focused mainly on antibiotic choice and timing5,6 and improving these processes7; however, a number of adjunctive measures have also been individually evaluated in high-risk populations (including patients who have colorectal surgery) and have shown promise in reducing SSI. These adjunctive measures include (1) omission of mechanical bowel preparation8; (2) preoperative and intraoperative patient warming9,10; (3) the use of an increased concentration of inspired oxygen during and immediately after the procedures' conclusion11; (4) limiting intraoperative intravenous fluid volumes12; and (5) the use of wound barriers to protect the surgical wound from contamination during the procedure13 (Table 1). Despite the evidence supporting these measures, most have not been widely adopted to clinical practice. Furthermore, the effect on SSI rate that these interventions may have when used as a bundled intervention has not been defined.