We developed an SSI reduction bundle to reduce the incidence of incisional SSI in patients undergoing radical cystectomy at our institution. Our bundle included barrier wound protection, in the form of the Alexis® retractor, changing of surgical gowns and gloves prior to wound closure, washing of fascia with proviodine/saline mix prior to skin closure, and application of an antibiotic-impregnated dressing to the wound. The SSI previous bundle was successfully applied to all patients undergoing cystectomy after March 1st, 2018, and resulted in an 80% reduction in the incidence of incisional SSI.
A major strength of this study was the accuracy of the study outcomes. All charts were manually reviewed for infection within 30-days post-operatively using a strict Center for Disease Control (CDC) criteria. These results were then cross-checked with institutional NSQIP data, which uses the same CDC definition, to ensure accuracy. We were also able to show that the implementation of such a preventative bundle is both feasible and can result in improved clinical outcomes at a large tertiary center.
One limitation of our study is that we are unable to determine which component of the bundle contributes the most to the reduction in incisional SSI. Therefore, further study on the individual components of the bundle, particularly the benefit of wound protection in patients undergoing radical cystectomy, is warranted. Ideally, future investigation of our bundle or its components would be done in a randomized fashion to avoid the inherent biases of a non-randomized, retrospective study design.
Written by: James Ross, MD, Resident, Department of Urology, University of Ottawa, Ottawa, Ontario; Luke T. Lavallée, MDCM, MSc, FRCSC, Associate Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Urologic Oncologist, Division of Urology, Department of Surgery, The Ottawa Hospital, General Campus, Assistant Professor, University of Ottawa, Ottawa, Ontario
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