Background

An elevated incidence of surgical-site infections (SSI), identified as 'Needs Improvement' in SAR, prompted initiation of a protocol to identify improvements that can be made in operative care for SSI prevention. The primary aim of the protocol was reduction in incidence of SSI and the secondary objective was reduction of SSI incidence to the goal of 'As Expected' on SAR.

Methods

Incidence rates for SSI (peripheral, organ/space) were examined for MBS surgeries performed between Jan-Dec 2023. Changes and additions to operative care included the following :1) use of chlorhexidine (CHG) wash in place of antibacterial soap for showering the day before and morning of surgery with documented use, 2 ) pre-op application of CHG, 3) HbA1c 30 days prior to surgery and strict perioperative glycemic control, 4) instructions to patients on proper wound care, 5) aggressive antibiotic therapy to avoid SSI infection for patients with previous antibiotic resistant infections, such as MRSA, and 6) proper documentation of surgical wounds to avoid incorrect labelling of SSI.

Results

From Jan-Dec 2021, SSI incidence for Roux-en-Y gastric bypass was identified as 'Needs Improvement' in SAR (rate = 3.33%). Between Jan-Dec 2022, six additional SSIs occurred (two peripheral, four organ/space) for a rate of 1.39% among all primary surgeries performed. Following initiation of the SSI prevention protocol Jan-Dec 2023, there have been no SSI occurrences (0/239 primary surgeries).

Conclusions

Surgical-site infections with MBS can be improved or prevented with appropriate operative care, including antimicrobial prophylaxis, perioperative glycemic control, and patient education.