Aiming for zero: Success of the hysterectomy surgical site infection prevention bundle

Background: The Center for Disease Control's National Healthcare Safety Network (NHSN) reported increased Standardized Infection Ratios (SIRs) for hysterectomy at a large community hospital. Objective: To promote a surgical site infection (SSI) prevention bundle implemented to reduce hysterectomy-associated SSI. Methods: A multidisciplinary Workgroup implemented the Hysterectomy SSI Prevention Bundle in 2020 to enforce standardization of perioperative techniques. This study included all benign hysterectomies pre-implementation (n = 857) and post-implementation (n = 772). Per NHSN categorization guidelines, "abdominal hysterectomy" includes both open and laparoscopic routes. "Inpatient surgery" is date of discharge different from date of surgery; "outpatient surgery" is same date of discharge. "SSI" includes superficial, deep, and organ/space; "complex SSI" includes deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. Results: After implementation of the SSI bundle, SIRs for hysterectomy were reduced to <1.0, indicating infection prevention. Reductions in SIR were significant for outpatient abdominal hysterectomy (0.868 [p = .007]), inpatient vaginal hysterectomy (0 [p < .001]), inpatient complex abdominal hysterectomy (0 [p = .040]), and inpatient complex vaginal hysterectomy (0 [p < .001]). Differences between groups were significant for increased laparoscopic and decreased vaginal hysterectomies (p < .001), increased outpatient surgeries (p < .001), and longer procedure duration (p < .001). Conclusion: Implementation of an SSI prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.