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Colorectal Bundle Project
Reducing Infections in Colorectal Surgery using a Bundle of Care
Overview
Thirty years of research have shown that proper prophylactic antibiotic selection and timing, clipping rather than shaving of hair, maintenance of normothermia and normoglycaemia,
adequate oxygenation and appropriate surgical technique are critical to reduce infection risk following surgery.
The documents here have been refined from a joint pilot project undertaken by the VICNISS Coordinating Centre and Southern Health, aimed at reducing infections in colorectal surgery.
Some of these measures, in particular normothermia, are currently used in hospitals in other parts of the world. In the United States normothermia is accepted as best practice for
surgery unless specifically contraindicated (for example, if the patient is undergoing neurosurgery).
The bundle of care developed here in Victoria included peri-operative normothermia, glucose control, adequate oxygenation and correct administration of antibiotic prophylaxis.
Process measures as well as outcomes were recorded, for example use of warming blankets was encouraged and documented in addition to temperature measurements.
Further Information
This material has been prepared to assist you if you wish to rollout this project. There are suggestions on how to get started and some resources designed to help with implementation.
- Measures to Reduce Surgical Site Infection Risk for Colorectal Surgery - Evidence for Bundle Recommendations
(PDF File
 31kb)
- Colorectal SSI Data Collection Rollout Guide
(PDF File
30kb)
- Colorectal SSI Patient Check List
(PDF File
150kb)
- Maintenance of Normothermia
(PDF File
34kb)
- References - A list of PDFs of selected references which are available with free and open access:
- Ata, A., et al., Postoperative hyperglycemia and surgical site infection in general surgery patients. Arch Surg. 145(9): p. 858-64
(PDF File
180kb)
- Belda, F.J., et al., Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. Jama, 2005. 294(16): p. 2035-42.
(PDF File
154kb)
- Capes, S.E., et al., Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke, 2001. 32(10): p. 2426-32.
(PDF File
186kb)
- Dellinger, E.P., Increasing inspired oxygen to decrease surgical site infection: time to shift the quality improvement research paradigm. Jama, 2005. 294(16): p. 2091-2.
(PDF File
117kb)
- Furnary, A.P., et al., Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac and Cardiovasc Surg, 2002. 125(5): p. 1007-21.
(PDF File
181kb)
- Greif, R., et al., Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med, 2000. 342(3): p. 161-7.
(PDF File
112kb)
- Kim, J. Y. et al., The effect of skin surface warming during anesthesia preparation on preventing redistribution hypothermia in the early operative period of off-pump coronary artery bypass surgery. Eur J Cardio-thoracic Surg, 2006. 29 : p.343-7.
(PDF File
95kb)
- Kurz, A., D.I. Sessler, and R. Lenhardt, Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med, 1996. 334(19): p. 1209-15.
(PDF File
131kb)
- Mauermann, W.J., and Nemergut, E.C., The Anesthesiologist's role in the prevention of surgical site infections. Anesthesiology, 2006. 105 : p. 413-21
(PDF File
1.3mb)
- Meyhoff, C.S., et al., Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA, 2009. 302(14): p. 1543-50.
(PDF File
286kb)
- Ouattara, A., et al., Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology, 2005. 103(4): p. 687-94.
(PDF File
396kb)
- Ozaki, M., et al., Nitrous oxide decreases the threshold for vasoconstriction less than sevoflurane or isoflurane. Anesth Analg, 1995. 80(6): p. 1212-6.
(PDF File
627kb)
- Qadan, M., et al., Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg, 2009. 144(4): p. 359-66; discussion 366-7.
(PDF File
150kb)
- Rassias, A.J., et al., Insulin infusion improves neutrophil function in diabetic cardiac surgery patients. Anesth Analg, 1999. 88(5): p. 1011-6.
(PDF File
123kb)
- Sessler, D.I., E.H. Rubinstein, and A. Moayeri, Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology, 1991. 75(4): p. 594-610.
(PDF File
1.5mb)
- Smith, R.L., et al., Wound infection after elective colorectal resection. Ann Surg, 2004. 239(5): p. 599-607.
(PDF File
330kb)
- Zerr, K.J., et al., Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg, 1997. 63(2): p. 356-61.
(HTML File
245kb)
Posters
Two posters are available on request from VICNISS, as displayed below:
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(PDF File  101kb, opens in new window).
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(PDF File 91kb, opens in new window).
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