IMPLEMENTATION OF A SURGICAL SITE INFECTION (SSI) PREVENTION BUNDLE FOR COLORECTAL SURGERY: EFFECT ON 30-DAY SUPERFICIAL, DEEP AND ORGAN-SPACE SSI RATES

Abstract

Objective: To determine the effect of implementation of a surgical site infection (SSI) prevention bundle on the frequency of 30-day superficial, deep and organ-space SSI in patients undergoing colorectal surgery. Study Design: Quasi-experimental, before-after (pre- and post-intervention) study. Setting: Department of Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Period: September 2025 to March 2026 (Group A reviewed retrospectively, September–December 2025; Group B enrolled prospectively over four months, January–March 2026). Material & Methods: Using non-probability purposive sampling, 160 patients undergoing elective or emergency colorectal resection (with or without anastomosis/stoma) were allocated to two groups of 80: Group A (pre-bundle, retrospective) and Group B (post-bundle, prospective). Group B received a structured six-element bundle comprising combined mechanical bowel preparation with oral antibiotics, pre-operative chlorhexidine bathing, intravenous antibiotic prophylaxis within 60 minutes of incision, 2% chlorhexidine-alcohol skin preparation, intraoperative normothermia, and glove/instrument change before closure. Patients were followed for 30 days for superficial incisional, deep incisional and organ/space SSI per CDC/NHSN criteria. Data were analysed on SPSS version 26 using the Chi-square/Fisher's exact test and independent samples t-test; p≤0.05 was significant. Results: The two groups were comparable at baseline for age, sex, BMI, comorbidities, ASA grade, indication, wound class and operative duration (all p>0.05). Overall 30-day SSI fell from 18.8% (15/80) in Group A to 2.5% (2/80) in Group B (relative risk 7.50, absolute risk reduction 16.2%, number needed to treat 6; p=0.001, Fisher's exact). Superficial SSI fell from 12.5% to 1.3% (p=0.009); deep and organ-space reductions were not independently significant given low event numbers. On logistic regression adjusting for age, BMI, diabetes and wound class, bundle implementation remained independently protective (adjusted odds ratio 0.09, 95% CI 0.02–0.42, p=0.002). Mean bundle compliance was 4.6/5 elements, with full compliance in 63.8% of Group B patients. Conclusion: Implementation of a low-cost, structured perioperative SSI prevention bundle was associated with a significant reduction in 30-day SSI, particularly superficial incisional infection, after colorectal surgery in this resource-limited South Asian setting.