Implementation of quality measures to reduce surgical site infection in colorectal patients

PURPOSE: The goal of this study was to determine the rate of surgical site infection and compliance with process measures designed to prevent infection in a defined population of patients undergoing colorectal operations. METHODS: A task-force consisting of surgeons, hospital infection control personnel, anesthesiologists, and nurses was convened to enforce the use of process measures to prevent infections. We monitored antibiotic selection, dosage, timing, redosing and discontinuation, hair removal technique, intraoperative and postoperative body temperature, and perioperative glucose control for 12 months by using electronic medical records. Patients underwent a minimum of 30 days of postoperative follow-up and the attending surgeon diagnosed infections. RESULTS: Between April 2006 and March 2007, 298 patients underwent abdominal colorectal operations. The overall infection rate was 20 percent for colon procedures and 11 percent for small-bowel procedures. Compliance for most process measures improved from the first to the fourth quarter, and during the final quarter, correct antibiotic dose and hair removal with clippers exceeded 90 percent. CONCLUSIONS: The rate of surgical site infection after colorectal surgery is likely to be higher than that reported in national quality improvement programs. Perfect compliance with performance measures may be difficult to attain.