Surgical Site Infection: Still Waiting on the Revolution

• Published in: JAMA : the journal of the American Medical Association Vol. 305; no. 14; pp. 1478 - 1479
• Main Authors: ANTHONY, Thomas, MURRAY, Bryce W, SUM-PING, John T, LENKOVSKY, Fima, VORNIK, Vadim D, PARKER, Betty J, MCFARLIN, Jackie E, HARTLESS, Kathleen, HUERTA, Sergio
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 13.04.2011
• Subjects: Abdominal surgery; Biological and medical sciences; Clinical outcomes; Evidence-based medicine; General aspects; Human infectious diseases. Experimental studies and models; Infections; Infectious diseases; Medical sciences; Medicine; Surgical wound; Nosocomial infection; Expectation
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.2011.447

Anthony et al determine if an evidenced-based practice bundle would result in a significantly lower rate of surgical site infections (SSIs) when compared with standard practice. The overall rate of SSI was 45% in the extended arm of the study and 24% in the standard arm (P=.003). Most of the increased number of infections in the extended arm were superficial incisional SSIs (36% extended arm vs 19% standard arm; P=.004). Multivariate analysis suggested that allocation to the extended arm of the trial conferred a 2.49-fold risk (95% confidence interval, 1.36-4.56; P=.003) independent of other factors traditionally associated with SSI. An evidenced-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.