Impact of Care Bundle Approach in Prevention of Surgical Site Infection in Abdominoplasty Patients Mabrouk AR*, Helal HA*, El-Mekkawy SF* and Abdallah MA** *Plastic Surgery Department, ** Clinical and Chemical Pathology Department Faculty of Medicine, Ain Shams University, Cairo, Egypt

“Nothing to disclose.”

Introduction Surgical site infection (SSI) is one of the most common healthcare associated infections. It is associated with compromised quality of life and an increase in morbidity and mortality.

Aim of the study is to; Detect the impact of a new care bundle elements in patients undergong abdominoplasty in order to decrease the rate of surgical site infection (SSI).

Patients and Methods Patients were divided into 2 groups; – Group 1: without implementing care bundle (50 patients). – Group 2: with implementing care bundle (50 patients). Follow up for 30 days after operation and search for SSI and calculation of its incidence rate.

Care Bundle Elements A. Preoperative Phase Ensure that patients were screened for MRSA and CRE. If hair removal was necessary, razors were not used. All Patients were showered on day of surgery using soap. Prophylactic antibiotic was administered within 60 minutes prior to the operation.

Perioperative phase 2% chlorhexidine gluconate in 70% isopropyl alcohol solution was used for skin preparation. Patient’s body temperature was maintained >36°C Diabetic patient’s glucose level was kept <200mg/dL Patient’s Hb saturation was maintained > 95%. Wound was covered with a sterile dressing at the end of surgery

Postoperative phase Wound dressing was kept in place for 48 hours after surgery unless clinically indicated. Aseptic technique was used if there is excess wound leakage and need for a dressing change. Hand hygiene was performed immediately before every aseptic dressing change.

Results (Patients’ Data) Group 1Group 2 Age31 ± ±2.4 ns BMI26 ± ±6.1 ns Active smoking 01ns Diabetes23ns

Results (Intra-operative) Group 1Group 2 Operation time (minutes) ns Drains100% ns

Results (Post-operative) Group 1Group 2 Mean hospital stay duration (days) ns Total Complications626P < 0.05 Overall incidence rate of clinically diagnosed SSI 4% (n=2)18% (n=9) P < 0.05 Positive Wound cultures23ns Re-hospitalization02P < 0.05 Re-operation02P < 0.05

Conclusion The results reported prove that, by applying an evidence-based care bundle to our surgical procedures, the risk of infection can be kept very low, thus optimizing the final outcomes.

Significance of findings Staphylococcus aureus was the most commonly isolated organism in the present study followed by E.coli, Klebsiella, Proteus and pseudomonas.

SSI rate of group 2 is considerably less than group 1. Significant association between co-morbidities and of SSI rates

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