Back to Journals » Infection and Drug Resistance » Volume 13

Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt

Authors Wassef M, Mukhtar A, Nabil A, Ezzelarab M, Ghaith D

Received 31 October 2019

Accepted for publication 14 January 2020

Published 28 January 2020 Volume 2020:13 Pages 229—236


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Mona Wassef,1 Ahmed Mukhtar,2 Ahmed Nabil,3 Moushira Ezzelarab,1 Doaa Ghaith1

1Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt; 3Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence: Doaa Ghaith
Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, 1st Al-Saray Street, Al-Manial, Cairo 11559, Egypt
Tel +20 100 1857775

Introduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance.
Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University.
Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection.
Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p< 0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd’s ratio (OR’s ratio = 0.3) confidence interval (95% CI 0.14– 0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%).
Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.

Keywords: colonization, OXA 48, MDR- Acinetobacter, ICU

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]