For a study, researchers sought to see if there was a connection between how often individual elements of a surgical site infection reduction bundle were used and infection rates. The study took place at hospitals that were a part of the Illinois Surgical Quality Improvement Collaborative. Patients who had surgery to remove their colons at any of these hospitals from 2016-2017 were studied. The intervention was a 16-element surgical site infection reduction bundle. Infection rates among patients who adhered to each element of the bundle were compared using X2 tests and multivariable logistic regression. The principal component analysis identified composites of correlated bundle elements. Coincidence analysis identified combinations of bundle elements or principal component composites associated with the absence of surgical site infection. About 192 (7.1%) of 2,722 patients got a surgical site infection. Infections were less likely when oral antibiotics (OR 0.63 [95% CI 0.41-0.97]), wound protectors (OR 0.55 [95% CI 0.37-0.81]), and occlusive dressings (OR 0.71 [95% CI 0.51-1.00]). The elements of the bundle were reduced into 5 principal composite components. Adherence with the combination of oral antibiotics, wound protector, or redosing intravenous antibiotic prophylaxis plus chlorhexidine-alcohol intraoperative skin preparation was associated with the absence of infection (consistency=0.94, coverage=0.96). About 4 of the 5 main composites of different types were linked with a lack of surgical site infection. However, the composite, including occlusive dressing, postoperative dressing removal, and daily postoperative chlorhexidine incisional cleansing, was not associated with this outcome. The inclusion of hospitals that are taking part in quality improvement initiatives might make these findings less generalizable. The elements included in bundles had varying associations with infection reduction. When implementing colorectal surgical site infection reduction bundles, focus on those elements linked with low rates of surgical site infections.

Source: journals.lww.com/dcrjournal/Fulltext/2022/08000/Unbundling_Bundles__Evaluating_the_Association_of.16.aspx