# The implementation of complex infection control bundles to prevent colorectal surgical site infections: a survey of SHEA research network hospitals

## TL;DR

This study surveyed hospitals to understand how often and how well infection control bundles are used to prevent surgical site infections in colorectal surgery.

## Contribution

The study provides new insights into the real-world implementation of infection control bundles for colorectal surgical site infections.

## Key findings

- Most hospitals use pre-operative antibiotics and alcohol-chlorhexidine skin prep for infection control.
- Fewer hospitals consistently audit and feedback surgical staff on bundle compliance.
- Resistance to change and clinician non-compliance are major barriers to bundle implementation.

## Abstract

Surgical site infections (SSI) result in significant patient morbidity and excess healthcare costs. Colorectal surgeries have the highest SSI risk, as they manipulate the organ with the largest endogenous bioburden. This risk can be mitigated through complex prevention bundles, shown effective at reducing SSI in multiple studies, although little is known about their “real-world” use.

To obtain further insight into the implementation of SSI prevention bundles consisting of guideline-recommended infection control elements in colorectal surgery, we distributed a multiple-choice survey to the hospitals within the Society for Healthcare Epidemiology of America Research Network from November 2022 to December 2023.

A total of 42 (45%) hospitals completed the survey. The bundle elements most used were intravenous pre-operative antibiotic prophylaxis (88%) and skin prep with an alcohol-chlorhexidine solution (86%). Infection control elements of surgical closure such as glove change and separate instrument tray were reported by 67% and 64%, respectively. Combined oral antibiotics with mechanical bowel prep were reported by 52%. Less than 50% of hospitals reported consistent bundle audit and feedback to frontline surgical staff. The most persistent barriers to implementation were a general culture resistant to change (40%) and clinicians’ lack of compliance with the institutional bundle (38%).

Our study found significant variability in the implementation of bundles consisting of multiple infection control elements to prevent SSI in clinical practice. Further research is needed to determine the strategies most effective in optimizing high-fidelity adoption of complex prevention bundles and to study their effect on SSI in colorectal surgery.