Observation of the Implementation of a Bundle of Care in Colorectal Surgery to Reduce Surgical Site Infections Successfully

NCT ID: NCT04677686

Last Updated: 2020-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

150 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-10-01

Study Completion Date

2021-09-30

Brief Summary

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This study aims to evaluate whether the colorectal bundle designed and implemented at Cantonal Hospital Lucerne, will lead to a significant reduction of SSIs. The impact of potential risk factors for SSIs will additionally be evaluated.

Detailed Description

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Surgical site infections (SSIs) remain a relevant problem in colorectal surgery. The aim of this study is to implement a bundle of care in order to reduce SSIs in colorectal surgery.

All patients undergoing colorectal surgery between October 2018 and September 2021 will be included in a prospective observational study. Since our colorectal bundle has been established gradually, patients will be grouped in a pre-implementation (2018-2019), implementation (2019-2020) and post implementation phase (2020-2021), in order to assess the effectiveness of the actions undertaken. Primary endpoint of this study will be surgical site infection (SSI) rate, while secondary endpoints encompass potential risk factors for SSIs. We assume that obesity, age, diabetes, alcoholism and smoking may lead to a higher risk for SSIs.

Conditions

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Reduction of Surgical Site Infections in Colorectal Surgery

Keywords

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colorectal surgery bundle of care surgical site infection

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Pre-implementation phase (October 2018 - September 2019)

During this time period, 137 patients underwent colorectal surgery. Only basic measures for preventing SSI were performed:

1. Hair was removed in the operating field with a clipper instead of shaving hair.
2. Blood glucose was monitored only during the operation.
3. Antibiotic prophylaxis was applied 60 minutes before the operation.
4. The application of an antibiotic prophylaxis was repeated if the operation lasted longer than 4 hours.
5. Measures of warming were only applied during the operation and in the recovery room.
6. Instruments and gloves were changed after finishing the anastomosis.

No interventions assigned to this group

Implementation phase (October 2019 - September 2020)

During this phase, additional measures have been introduced:

1. Implementation of wound protectors during colorectal surgery.
2. Colorectal operations were only performed with the support of an experienced consultant surgeon.

No interventions assigned to this group

Post-implementation phase (October 2020 - September 2021)

During this phase, additional measures are implemented.

1. Close monitoring of blood glucose. During the stay in the recovery room and for 48 hours post-operative, blood glucose is monitored closely. Moreover, if blood glucose is higher than 9 mmol/l, the patient will be treated with insulin. This measure is applied to diabetic as well as to non-diabetic-patients.
2. The measures of warming will be intensified. First of all, during the operation and during the stay in the recovery room patients will be placed on warming mattresses. Moreover, a warming towel will be placed on the operating field directly after the operation.
3. The patients will be asked to take a shower the night before surgery. In case of an emergency operation, patients will be asked to wash the axilla, trunk, genitalia, groins and umbilicus

Bundle of Care

Intervention Type BEHAVIORAL

Hair removal with Clipper Glucose Control Preoperative antibiotics Repeat antibiotics after 4 Hours Optimize Body temperature Instrument change for colorectal anastomosis Use of wound protectors Experienced surgeon Preoperative showering

Interventions

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Bundle of Care

Hair removal with Clipper Glucose Control Preoperative antibiotics Repeat antibiotics after 4 Hours Optimize Body temperature Instrument change for colorectal anastomosis Use of wound protectors Experienced surgeon Preoperative showering

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

over 18 elective or emergency colorectal surgery written informed consent

Exclusion Criteria

pregnant no informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Luzerner Kantonsspital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jörn-Markus Gass

Role: PRINCIPAL_INVESTIGATOR

Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16

Locations

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Cantonal Hospital of Lucerne

Lucerne, , Switzerland

Site Status RECRUITING

Countries

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Switzerland

Central Contacts

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Jörn-Markus Gass

Role: CONTACT

Phone: 0041412854835

Email: [email protected]

Facility Contacts

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Jörn-Markus Gass

Role: primary

References

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Brunner S, Liesenberg J, Fourie L, Metzger J, Scheiwiller A, Zschokke I, Lehnick D, Gass JM. Implementation of a Bundle of Care in Colorectal Surgery to Reduce Surgical Site Infections Successfully at Cantonal Hospital Lucerne: Study Protocol for a Prospective Observational Study. Int J Surg Protoc. 2021 Sep 23;25(1):220-226. doi: 10.29337/ijsp.150. eCollection 2021.

Reference Type DERIVED
PMID: 34616960 (View on PubMed)

Other Identifiers

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220-00051

Identifier Type: -

Identifier Source: org_study_id