eP84 The good, the bad, and the ugly - use of a care bundle reduces surgical site infection after all grades of contaminated emergency laparotomy

Aim

The following care-bundle has halved surgical site infection (SSI) after elective colorectal surgery from 20% to 10%.2% chlorhexidine skin preparationSecond dose of antibiotics after 4 hoursDual-ring wound protectorAntibacterial sutures for deep closure and skin

The bundle was adapted for emergency laparotomy and two elements added:Glove changeBetadine wound wash

Overall, SSI rates were reduced. However, this analysis will assess whether the bundle is effective at all levels of intra-operative contamination.

Methods

30-day patient reported SSI was measured using the Health Security Agency questionnaire with a response rate of 71%. For 25% of patients with a length of stay >30 days, SSI was measured by in-hospital surveillance. Data was collected for 178consecutive patients before, and 604 patients after intervention. Patients who had trauma, enterocutaneous fistulae, death before 30 daysor who never had skin closure were excluded. Contamination code assigned using OPCS guidelines.Infection rates were compared pre and post intervention across clean, clean contaminated and dirty surgeries. Chi2 test was used to test significance at p<0.05.

Results

  Pre-intervention Post-intervention Classification SSI No SSI Infection % SSI No SSI Infection % p= Clean 3 10 23% 7 54 11.5% 0.266609 Clean-contaminated 17 47 26.5% 18 105 14.6% 0.047232 Dirty 17 14 55% 15 68 18% 0.000101 Overall 37 71 34% 40 227 15% 0.000029

Conclusion

This bundle is associated with a significant reduction in SSI across all degrees of contaminated emergency laparotomy. This was most effective in dirty cases.