Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery

Kerri A. Ohman, Leping Wan, Tracey Guthrie, Bonnie Johnston, Jennifer A. Leinicke, Sean C. Glasgow, Steven R. Hunt, Matthew G. Mutch, Paul E. Wise, Matthew L. Silviera

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. Study Design: A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a “clean-closure” protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. Results: For the 24 months pre-IPB, the overall SSI rate was 19.7%. During the 30 months after IPB implementation, the SSI rate decreased to 8.2% (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6% vs 16.2%; p = 0.005), oral antibiotics (3.4% vs 15.4%; p < 0.001), and mechanical bowel preparation (4.4% vs 14.3%; p = 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7% SSI rate compared with 15.8% for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95% CI 0.1 to 0.9; p = 0.006). Conclusions: Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI.

Original languageEnglish (US)
Pages (from-to)465-471
Number of pages7
JournalJournal of the American College of Surgeons
Volume225
Issue number4
DOIs
StatePublished - Oct 2017

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Surgical Wound Infection
Colorectal Surgery
Anti-Bacterial Agents
Infection
Chlorhexidine
Databases
Hair Removal
Compliance
Oral Administration
Multivariate Analysis
Odds Ratio
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery. / Ohman, Kerri A.; Wan, Leping; Guthrie, Tracey; Johnston, Bonnie; Leinicke, Jennifer A.; Glasgow, Sean C.; Hunt, Steven R.; Mutch, Matthew G.; Wise, Paul E.; Silviera, Matthew L.

In: Journal of the American College of Surgeons, Vol. 225, No. 4, 10.2017, p. 465-471.

Research output: Contribution to journalArticle

Ohman, Kerri A. ; Wan, Leping ; Guthrie, Tracey ; Johnston, Bonnie ; Leinicke, Jennifer A. ; Glasgow, Sean C. ; Hunt, Steven R. ; Mutch, Matthew G. ; Wise, Paul E. ; Silviera, Matthew L. / Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery. In: Journal of the American College of Surgeons. 2017 ; Vol. 225, No. 4. pp. 465-471.
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abstract = "Background: Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. Study Design: A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a “clean-closure” protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. Results: For the 24 months pre-IPB, the overall SSI rate was 19.7{\%}. During the 30 months after IPB implementation, the SSI rate decreased to 8.2{\%} (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6{\%} vs 16.2{\%}; p = 0.005), oral antibiotics (3.4{\%} vs 15.4{\%}; p < 0.001), and mechanical bowel preparation (4.4{\%} vs 14.3{\%}; p = 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7{\%} SSI rate compared with 15.8{\%} for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95{\%} CI 0.1 to 0.9; p = 0.006). Conclusions: Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI.",
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AU - Wan, Leping

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AU - Johnston, Bonnie

AU - Leinicke, Jennifer A.

AU - Glasgow, Sean C.

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AU - Mutch, Matthew G.

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AU - Silviera, Matthew L.

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AB - Background: Surgical site infections (SSI) are a common complication after colorectal surgery. An infection prevention bundle (IPB) was implemented to improve outcomes. Study Design: A standardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation, preoperative shower with chlorhexidine, hair removal and skin preparation in holding, antibiotic wound irrigation, and a “clean-closure” protocol was implemented in January 2013. Data from the American College of Surgeons NSQIP were analyzed at a single academic institution to compare pre-IPB and post-IPB SSI rates. In January 2014, a prospective database was implemented to determine compliance with individual IPB elements and their effect on outcomes. Results: For the 24 months pre-IPB, the overall SSI rate was 19.7%. During the 30 months after IPB implementation, the SSI rate decreased to 8.2% (p < 0.0001). A subset of 307 patients was identified in both NSQIP and our prospective compliance databases. Elements of IPB associated with decreased SSI rates included preoperative shower with chlorhexidine (4.6% vs 16.2%; p = 0.005), oral antibiotics (3.4% vs 15.4%; p < 0.001), and mechanical bowel preparation (4.4% vs 14.3%; p = 0.008). Patients who received a full bowel preparation of both oral antibiotics and a mechanical bowel preparation had a 2.7% SSI rate compared with 15.8% for all others (p < 0.001). On multivariate analysis, full bowel preparation was independently associated with significantly fewer SSI (adjusted odds ratio 0.2; 95% CI 0.1 to 0.9; p = 0.006). Conclusions: Implementation of an IPB was successful in decreasing SSI rates in colorectal surgery patients. The combination of oral antibiotics with a mechanical bowel preparation was the strongest predictor of decreased SSI.

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