Compliance With Surgical Site Infection (SSI) Prevention Bundle, A Pilot Study In A Saudi Arabian Cardiac Centre

Background:

SSIs compose up to 20% of all of healthcare-associated infections.The SSI bundle is a group of evidence-based interventions for patients experiencing surgery which when implemented together, result in better outcomes.
An estimated 40 to 60 percent of these infections are preventable. 

Objective:

To evaluate the compliance of the surgical team with the components of SSI bundle.

Methods:

Prospective pilot study conducted in a 160 beds tertiary care cardiac center from the 30^th July to 18^th September 2007. A data collection sheet was designed consisting of patient’s demographics, date and type of surgery, hair removal method, antibiotic choice, timing, and duration in addition to blood glucose control pre, intra, and postoperatively on day one and two. Out of all patients who underwent median sternotomy for valve replacement, Coronary Artery Bypass Grafting (CABG), or other cardiac procedures, 100 consecutive adult patients aged ≥ 13 years were surveyed for the study.The infection control nurse collected the data which was analyzed by the infection control epidemiologist using the SPSS program. Univariate analysis was done for all variables.

Results:

The mean age was 53.37 (maximum 81, minimum 15). The highest percentage of study population underwent CABG (46%), followed by heart valve surgery (33%), while other cardiac procedures accounted for only 21%. Within 60 minutes before the incision all patients received preoperative antibiotics which were administered at induction of anesthesia. Cefuroxime  was the most frequently used prophylaxis (82%). Vancomycin was rarely used as a single agent in 3% of patients, or as a combination with ceftazidime (2%), or pipracillin/ tazobactam (2%) Antibiotics were discontinued within 24 hours in only 8% of patients, the remaining continued to use prophylaxis postoperatively for variable periods of time. Preoperative hair removal was universally practiced. In 97% of patients electric clippers were used while the remaining were shaved using razors.

Preoperative glucose level was ranging from 4-5.9 mmol in 43% of study population, while 37% of patients had their glucose level between 6-10 mmol and 20% had a level of >10 mmol/l. Intraoperative glucose was between 4-5.9 in 14.3%, 6-10 in 71.4%, and >10 in 14.3%. Post-operative day one, glucose level was 4-5.9 in 5.3%, 6-10 in 45.2%, and >10 in 49.5%. On postoperative day 2, 14.9 % of patients achieved a glucose level of 4-5.9, while 59.6% had a level ranging from 6-10, and 25.5 % had a glucose level of >10 mmol

Conclusions:

This study reflected a good compliance with international standards of SSI bundle in the choice and timing of antibiotics; hair removal method and preoperative glycemic control but grossly fell short of the recommendations in terms of antibiotic discontinuation within 24 hours and postoperative control of blood glucose.