“EFFECT OF INTEGRATED SURGICAL SITE INFECTION (SSI) BUNDLE AND ANTIMICROBIAL STEWARDSHIP ON SSI RATES IN A TERTIARY-CARE TEACHING HOSPITAL: A PRE–POST INTERVENTION STUDY”
Main Article Content
Keywords
Surgical Site Infection; SSI Bundle; Antimicrobial Stewardship; Prophylaxis; IPC; Surgical Safety; CHG preparation; Antibiotic Timing
Abstract
Surgical Site Infection (SSI) is one of the most common preventable postoperative complications, contributing significantly to morbidity, prolonged hospital stays, and increased antimicrobial use. LMICs, including India, report higher SSI rates due to limited adherence to Infection Prevention and Control (IPC) practices, inconsistent aseptic technique, and rising antimicrobial resistance. Evidence suggests that structured SSI-prevention bundles and Antimicrobial Stewardship (AMS) interventions can significantly reduce SSI burden when implemented effectively. This study evaluates the impact of an integrated SSI bundle and AMS program on SSI rates in a tertiary-care teaching hospital.
Material and Methods: A pre–post intervention study was conducted in surgical units over 18 months. A total of 600 patients undergoing clean and clean-contaminated surgeries were included (300 pre-intervention and 300 post-intervention). The SSI bundle consisted of preoperative CHG bathing, timely antibiotic prophylaxis, optimal skin preparation, normothermia maintenance, glycemic control, and sterile surgical practices. AMS interventions included optimizing prophylactic antibiotic choice, timing, and duration aligned with WHO and CDC guidelines. SSI surveillance was conducted using CDC/NHSN criteria up to 30 days post-surgery. Rates were calculated per 100 surgeries.
Results: SSI rates decreased from 9.6% in the pre-intervention phase to 4.3% in the post-intervention phase (55% reduction; p=0.032). Timely antibiotic prophylaxis improved from 61% to 88%, and inappropriate prolonged antibiotic use decreased from 47% to 19%. CHG-based skin preparation compliance improved from 54% to 87%. Clean surgeries showed the most significant decline in SSI. Gram-negative organisms, including Klebsiella and Pseudomonas, were predominant in pre-intervention cultures, whereas post-intervention isolates decreased significantly.
Conclusion: Implementation of an integrated SSI-prevention bundle combined with AMS interventions resulted in a substantial reduction in SSI rates. The study demonstrates that simple, evidence-based, low-cost practices—supported by antimicrobial governance—can significantly improve surgical outcomes in resource-limited settings. Sustained adherence and surveillance are essential for long-term success.
References
2. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. CDC guideline for prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–791. doi:10.1001/jamasurg.2017.0904.
3. Tuuli MG, Liu J, Stout MJ, et al. Chlorhexidine-alcohol vs povidone-iodine for surgical-site antisepsis. JAMA Surg. 2016;151(3):226-236. doi:10.1001/jamasurg.2015.4235.
4. Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine–alcohol for surgical-site antisepsis. N Engl J Med. 2010;362:18-26. doi:10.1056/NEJMoa0810988.
5. Taneja N, Singh R, Gupta A, et al. SSI incidence and risk factors in North India: a prospective study. J Clin Diagn Res. 2020;14(4):DC05-DC10. doi:10.7860/JCDR/2020/43892.13645.
6. Singh D, Devasia A, Dutta TK, et al. SSI following GI surgeries: risk factors and bacterial profile. Clin Epidemiol Glob Health. 2019;7(4):540–544. doi:10.1016/j.cegh.2019.01.003.
7. Gupta S, Kumar D, Gupta SK, et al. SSI and antimicrobial resistance patterns in orthopedics. Cureus. 2021;13(5):e14875. doi:10.7759/cureus.14875.
8. Howard P, Pulcini C, Hara GL, et al. Global AMS program performance. Clin Microbiol Infect. 2019;25(8):1020–1027. doi:10.1016/j.cmi.2019.01.013.
9. WHO AWaRe classification of antibiotics. WHO; 2019. doi:10.2471/BLT.19.231845.
10. Chaturvedi S, Nag V, Yadav P. CAUTI/SSI bundle implementation: outcomes & barriers. J Infect Dev Ctries. 2021;15(10):1465–1472. doi:10.3855/jidc.14341.
11. Alkaaki A, Al-Radi OO, Khoja A, et al. SSI in abdominal surgeries: meta-analysis. World J Surg. 2019;43:1375–1385. doi:10.1007/s00268-019-04953-6.
12. Banerjee T, Anupurba S. Trends in SSI pathogens in India (2015–2020). J Infect Public Health. 2020;13(12):2032–2037. doi:10.1016/j.jiph.2020.11.002.
13. Rosenthal VD, Mehta Y, Leblebicioglu H, et al. Impact of IPC bundles in LMICs. Infect Control Hosp Epidemiol. 2021;42(7):882–893. doi:10.1017/ice.2020.1293.
14. Misra R, Sarangi PP, Mishra B, et al. Effectiveness of multimodal VAP/SSI bundle in resource-limited ICUs. J Hosp Infect. 2021;111:87–94. doi:10.1016/j.jhin.2021.02.015.
15. Goel G, Gupta M, Walia K. ICMR AMR surveillance—achievements & updates. Indian J Med Res. 2019;149(2):179–188. doi:10.4103/ijmr.IJMR_313_18.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Javed Ali
Department of Microbiology, Index Medical College Hospital & Research Centre, Indore, India
Dr. Dr Kailash Jatav
Department of Microbiology, Index Medical College Hospital & Research Centre, Indore, India
Dr. Ramanath Kericheri
Department of Microbiology, Index Medical College Hospital & Research Centre, Indore, India
Dr. Abhiraj Ramchandani
Department of Pathology, Amaltas Institute of Medical Sciences, Dewas, India
