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The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgical site infections (SSIs) lead to increased patient morbidity and healthcare costs. Our objective was to decrease the SSI rate following gynecologic surgery.

Methods

Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following: patient education; preoperative antibacterial soap; appropriate antibiotic prophylaxis; change of gloves and use of clean instruments at surgical closure; surgical dressing for 48 h; and a post-discharge phone call. The baseline SSI rate was determined retrospectively (1 April 2014–30 June 2014), while the post-intervention SSI rate was determined prospectively (16 February 2015–15 October 2015). The main outcome was the overall SSI rate with secondary outcomes, including the rate of superficial, deep, incisional and organ space infection, as well as the cost effectiveness of the bundle.

Results

A total of 232 baseline and 555 post-intervention patients were included in the study. No differences were observed between the baseline and post-intervention groups with regard to median body mass index (BMI), surgical approach, receipt of preoperative chemotherapy and/or radiation therapy, and cases including bowel surgery. Overall, the SSI rate decreased significantly from baseline [12.5 %] to post-intervention [7.4 %] (odds ratio [OR] 0.56, 90 % confidence interval [CI] 0.37–0.85; p = 0.01). A 40 % decrease was noted in the rate of superficial and deep infections (9.5 vs. 5.9 %; OR 0.60, 90 % CI 0.38–0.97; p = 0.04) and SSIs after open surgery (21.4 vs. 13.2 %; OR 0.56, 90 % CI 0.34–0.92; p = 0.03). The estimated cost of the intervention was $19.26/case and the net total amount saved during the post-intervention period was $65,625 month.

Conclusions

This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective. The largest decreases in SSIs were in incisional infections and following open surgery.

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Acknowledgments

The authors would like to acknowledge the following people for their contributions to this initiative: Katherine E. Cain, PharmD; Lynn M. Cloutier, RN, MSN, ACNP-BC; Shauna L. Fenton, RN, MSN; Linda S. Graviss, MT (ASCP), CIC; Cheryl A. Hubbs, RN; Deepthi A. James, MSN, RN, FNP-C; Johnrich R. Levine, MSN, MHA, MPA, BSN, RN, PNE-C; Keith N. Myers, BS; Anne K. Park, MS, MPH; Deandra Sandles, RN, MSN, CNOR; Tara N. Tatum, RN, MBA; Shital Vachhani, MD; Kathy M. Ware, RN.

Financial Support

This research was supported in part by the National Institutes of Health (NIH) through MD Anderson Cancer Center’s Support Grant CA016672. Dr. Taylor’s work on this project was supported by an NIH T32 grant, Training of Academic Gynecologic Oncologists, from the National Cancer Institute (5T32-CA101642). The funding source had no direct role in preparing or reviewing this study nor this manuscript.

Disclosure

Larissa A. Meyer has received honoraria from TRM Oncology, and research funding from AstraZeneca. Kathleen M. Schemler has received research funding from Cepheid, and patents, royalties or other intellectual property from UpToDate. Jolyn S. Taylor, Claire A. Marten, Mark F. Munsell, Charlotte C. Sun, Kimberly A. Potts, Jennifer K. Burzawa, Alpa M. Nick, Keith Myers, Diane C. Bodurka, Thomas A. Aloia, Charles F. Levenback, David R. Lairson, and Kathleen M. Schmeler report no conflicts of interest.

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Authors and Affiliations

  1. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jolyn S. Taylor MD, MPH, Charlotte C. Sun DrPh, Jennifer K. Burzawa MD, Alpa M. Nick MD, MS, Larissa A. Meyer MD, MPH, Keith Myers BS, Charles F. Levenback MD & Kathleen M. Schmeler MD

  2. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Claire A. Marten PharmD

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mark F. Munsell MS

  4. Department of Perioperative Services, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kimberly A. Potts RN

  5. Department of Clinical Education, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Diane C. Bodurka MD, MPH

  6. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Thomas A. Aloia MD

  7. Department of Management and Policy Sciences, The University of Texas School of Public Health, Houston, TX, USA

    David R. Lairson PhD

Authors
  1. Jolyn S. Taylor MD, MPH
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  2. Claire A. Marten PharmD
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  3. Mark F. Munsell MS
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  4. Charlotte C. Sun DrPh
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  6. Jennifer K. Burzawa MD
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  7. Alpa M. Nick MD, MS
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  8. Larissa A. Meyer MD, MPH
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  9. Keith Myers BS
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  10. Diane C. Bodurka MD, MPH
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  11. Thomas A. Aloia MD
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  12. Charles F. Levenback MD
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  13. David R. Lairson PhD
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  14. Kathleen M. Schmeler MD
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Corresponding author

Correspondence to Kathleen M. Schmeler MD.

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Taylor, J.S., Marten, C.A., Munsell, M.F. et al. The DISINFECT Initiative: Decreasing the Incidence of Surgical INFECTions in Gynecologic Oncology. Ann Surg Oncol 24, 362–368 (2017). https://doi.org/10.1245/s10434-016-5517-4

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  • DOI: https://doi.org/10.1245/s10434-016-5517-4

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