8 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E M A Y 2 0 1 6
patients who are scheduled for joint replacement procedures, so they're placed on
a care pathway that ensures they're treated with the required bundle.
Proven results
Evidence touting the effectiveness of bundled care is out there. Researchers at
Duke University Medical Center in Durham, N.C., created an SSI-prevention
bundle — it included staff educational materials, disinfecting showers before
surgery, antibiotics administration and wound care — in 2011 and compared
infection rates in 346 patients who underwent colorectal surgery before the bun-
dle was implemented and 213 who were operated on afterward. The bundle
helped reduce the rate of superficial SSIs from 19% to 6% and post-op sepsis
from 8.5% to 2.5%, according to the findings, which were published in JAMA
Surgery (osmag.net/dQ7gZP).
At Johns Hopkins, we implemented a bundled approach to prevent SSIs dur-
ing colorectal procedures. The bundle established best practices for antibiotic
selection and dosing, skin preparation, maintenance of normal body tempera-
ture and intraoperative sterile technique. The interventions were implemented
gradually over 5 years, during which time our infection rate dropped from 30%
to 6%. Our findings show that a standardized, team-led approach to infection
prevention works. They also show that it takes time and a lot of work to get the
staff engaged, gather feedback about issues they face on the front line and
implement the changes needed to make real improvement happen.
Expected evolution
Surgical teams appreciate transparency and structure. Bundles provide that.
Teams also want feedback about their performance. That's where you come in.
Educate staff so they're aware of the different standards and policies that cover
the best ways to prevent infections. Every stakeholder in the process must
receive that message. If you share how and why a bundle was built with clinical
managers, also include the frontline staff in the conversations so they have an
