QAPI 134 - Implementation of Evidence-based Guidelines to Reduce Colorectal Surgery Site Infections

Background: Surgical site infections (SSI) can lead to complications including prolonged length of stay, increased hospital costs, additional procedures, readmissions, and even death. Patients are placed at an increased risk of infection in acute care settings when undergoing elective and traumatic colorectal surgeries. The Centers for Disease Control and Prevention (CDC) has published evidence-based guidelines to prevent infections related to colorectal surgeries.

Methods: The aim of this project was to implement these strategies to reduce the colorectal surgery Standard Infection Ratio (SIR) at a Level I trauma academic medical center. In January 2021, a multi-disciplinary team was created to perform a GAP analysis and develop interventions to decrease the SIR. Evaluation of current practices revealed a lack of physician communication, inconsistent documentation, and the need to standardize care and education. Interventions began by improving physician engagement, communication, and documentation. This led to a better understanding of workflow, barriers within the perioperative phase, and opportunities for improvement. Further interventions standardized the processes for distinguishing high-risk surgeries, antibiotic availability, and pre-operative infection prevention strategies. A control phase was implemented in November 2021 to maintain results by monitoring the SIR and reviewing and submitting all colon SSIs to a Surgical Quality Group, allowing for obstacles to be addressed and follow-up to occur as needed.

Results: The baseline data is from July 2019-Jan 2021. There were 510 procedures, 29 infections, and the SIR was 1.717. Post intervention data is from November 2021-May 2023. There were 511 procedures, 12 infections, and the SIR was 0.751. The decrease in surgical site infections was proven to be clinically significant by performing a Chi-Square test (p=.009).

Conclusions: Implementation of the colorectal SSI guidelines, focusing on physician engagement and standardization of practices resulted in a reduction of surgical site infections.