Standardized preoperative, surgical, antibiotic practices improve orthopedic, colorectal, abdominal surgery outcomes

Mortality, length of stay, readmissions, and surgical site infections (SSI) all declined after a six-state hospital system implemented a comprehensive surgical site infection (SSI) prevention bundle, according to a report presented today at the 2024 APIC Annual Conference.

The oral abstract, "Effect of a Standardized Preoperative Prophylactic Antimicrobial Guideline on Improved Postoperative Surgical Site Infection (SSI) Outcomes," (ISR 11) is being presented at 2:30 pm CT, June 4, at the APIC Annual Conference in San Antonio, Texas.

Banner Health, which operates facilities in Arizona, California, Colorado, Nebraska, Nevada, and Wyoming, reported on the impact of a surgical antimicrobial prophylaxis (SAP) bundle on more than 57,000 surgical cases from January 2019 to December 2023. Four publicly reportable procedures were included in the analysis: hip and knee arthroplasty, colorectal surgery, and abdominal hysterectomy.

The infection prevention (IP) team at Banner Health began investigating an all-encompassing clinical practice for SSI prevention in 2019 with the goal of reducing their Standardized Infection Ratios (SIRs). It was determined that focusing on one bundle component, specifically SAP across all 30 of their facilities, could have the greatest impact on SSI reduction. As part of the intervention, they monitored adherence to the appropriate selection of preoperative antibiotics, dose, administration times, and redose. Starting from a baseline of 67.1% in 2019, adherence to this process measure increased to 82.2% by 2023.

During the same period, compliance with the SAP bundle produced the beneficial effect of shortening length of stay (LOS) by 4 days, decreasing overall mortality rates by 4.4%, and lowering the average 30-day readmission rates by 3.9%. Similarly, compliance with the SAP bundle in hip arthroplasty procedures evidenced a statistically significant (p<0.0001) reduction in average 30-day readmission rates from 11% to 7%.

"This work shows that a bundle of evidence-based interventions designed to reduce infections can also impact other important outcomes like mortality, length of stay, and readmissions," said Aarikha D'Souza, BS, MPH, CIC, FAPIC, clinical practice lead and infection prevention regional director at Banner Health. "If we're sending patients home earlier there's a ripple effect as we also decrease the chances of them developing deep vein thrombosis, pneumonia, pressure injuries, or having a fall."

Increased adherence to the SAP bundle illustrated the most benefit among orthopedic patients. Hip arthroplasty procedures resulted in a statistically significant 32.8% decrease in SSI rates and 48.3% drop in SIR, while knee arthroplasty procedures resulted in a 15.2% reduction in SSI rates and 33.1% decrease in SIR. Additionally, adherence to the SAP bundle in colorectal surgeries and abdominal hysterectomy procedures decreased SSI rates by 17.4% and SIR by 8.11%, respectively.

"This project shows the value of intense focus on a specific set of process measures to influence not just infection rates, but also other important quality metrics," said Tania Bubb, Ph.D., RN, CIC, FAPIC, 2024 APIC president. "We are grateful to Banner Health for their exceptional patient safety work and for sharing their success at the APIC Conference."