Efficacy of Protocol Implementation on Incidence of Wound Infection in Colorectal Operations

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Abstract
We reported previously a 26% incidence of surgical site infection (SSI) in patients undergoing elective colorectal resection. Multiple risk factors have been identified, including obesity, improper administration of prophylactic antibiotics, hypothermia, and poor glycemic control. We hypothesized that implementation of a multidisciplinary wound management protocol targeting these risk factors would reduce the incidence of SSI. Previously reported baseline data were collected from February 2000 to January 2002. Beginning September 2004, the protocol was implemented, including appropriate administration of prophylactic antibiotics 0 to 60 minutes before incision, continued antibiotic administration for ≤ 24 hours postoperatively, maintenance of intraoperative normothermia (> 36°C), improved glycemic control (goal < 200 mg/dL 48 hours postoperatively) in diabetic patients, and placement of penrose drains in the subcutaneous space of patients with a body mass index ≥ 25. Data were collected on patients undergoing elective colorectal resection from January 2005 to August 2005 and compared with baseline. One hundred seventy-five and 132 patients during the baseline and study periods, respectively, met criteria for inclusion. Compliance with administration of prophylactic antibiotics increased from 68% to 91% (p ≤ 0.0001), and compliance with cessation within 24 hours increased from 71% to 93% (p ≤ 0.0001). Compliance with normothermia increased from 64% to 71% (p = 0.25). Incidence of SSI fell from 25.6% to 15.9% (p ≤ 0.05). After implementation of a multidisciplinary wound-management protocol, incidence of SSI improved 39%. These results demonstrate that compliance with a prospectively designed protocol for perioperative care can effectively reduce operative morbidity in patients undergoing colorectal operations.