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Bundle approach in emergency surgery for prevention of surgical site infections: a double-blinded randomized controlled trial

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Abstract

Introduction

Many studies have demonstrated significant antibiotic resistance by commonly isolated organisms. This is an eye-opener for the clinicians, who prescribe antibiotics day in and out. This situation shifts our attention towards the usage of antiseptic measures, which can at times play an important role in preventing and treating various infections.

Method

This is a double-blinded randomized controlled study that compares the bundle approach to the conventional approach for the prevention of surgical site infections in patients of peritonitis undergoing midline laparotomy in emergency. The bundle approach includes three measures, namely, painting of surgical site with chlorhexidine, dabbing the wound with povidone-iodine after the closure of the rectus sheath, and application of chlorhexidine-impregnated gauze piece over the skin wound.

Results

The total sample size was 64 (32 in each arm). The rate of surgical site infection was significantly lower in the test arm (21.8%) as compared to the conventional arm (46.8%). The mean length of hospital stay was shorter by one day in the test arm, although, not significant. The isolates from the peritoneal fluid culture and wound culture were mostly gram-negative organisms. Most of the organisms exhibited resistance toward third generation cephalosporins, fluoroquinolones, and aminoglycosides.

Conclusion

Antibiotic resistance is a burning concern in today’s world. Alternative methods of preventing infection in the form of using antiseptics should be sought. Although our study was limited to emergency cases, this bundle approach can be implemented in elective cases as well.

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Author information

Authors and Affiliations

  1. Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India

    SManwar Ali, Manash Ranjan Sahoo, Bikram Rout & Swastik Sourav Mishra

  2. Department of Obstetrics and Gynaecology, Government Medical College, Jajpur, Odisha, India

    Leesa Misra

  3. AIIMS, Delhi, New Delhi, India

    Vikram V.S.

  4. Department of Microbiology, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India

    Ashoka Mahapatra

Authors
  1. SManwar Ali
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  2. Leesa Misra
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  3. Manash Ranjan Sahoo
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  4. Vikram V.S.
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  5. Ashoka Mahapatra
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  6. Bikram Rout
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  7. Swastik Sourav Mishra
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Contributions

SMA, LS, and MRS contributed to the concept and design of the study and first draft of the manuscript. AM and BK reviewed the literature and helped in the preparation of the manuscript. VVS and SSM designed the final draft of the manuscript.

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Correspondence to Manash Ranjan Sahoo.

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Ali, S., Misra, L., Sahoo, M.R. et al. Bundle approach in emergency surgery for prevention of surgical site infections: a double-blinded randomized controlled trial. Langenbecks Arch Surg 409, 62 (2024). https://doi.org/10.1007/s00423-024-03243-w

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