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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

DOI https://doi.org/10.2147/IDR.S236814

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
Email doaa.ghaith@kasralainy.edu.eg

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

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