54: variation in compliance with colorectal surgical site infection prevention bundle

Introduction: Surgical Site Infections (SSI) are a major contributor to increased patient morbidity and mortality, with an estimated mortality rate of 3%. SSIs are linked to significantly increased hospital costs (over $3 billion annually in the US), length of stay, ICU stay, and readmission in postoperative patients. Approximately 25% of colorectal surgery patients acquire a SSI. The Solutions for Patient Safety (SPS) quality improvement collaborative has organized a cohort of children’s hospitals focused on reduction of colorectal SSI by implementing four prevention factors: preoperative chlorhexidine bathing, proper antibiotic selection and timing, use of surgical closing protocol, and appropriate bowel preparation (antibiotic and/or mechanical). Methods: From January 2021 to April 2022, 52 pediatric colorectal surgeries (47 colon, 5 rectal) were performed by 7 different surgeons. Postoperative notes, flowsheets, and the medication administration record were utilized for data collection to analyze compliance with the four prevention factors. Each primary surgeon was then assigned a random provider number to identify individual compliance to facilitate anonymous data-sharing. Results: Overall compliance with each prevention factor in the 52 colorectal surgeries includes: Preoperative chlorhexidine bathing 90%, mechanical bowel preparation 58%, antibiotic bowel preparation 56%, combined antibiotic and mechanical bowel preparation 44%, antibiotic prophylaxis 44%, and sterile closing protocol 2%. There was a wide range in compliance with the total bundle across the 7 different surgeons (34-64%, mean 45%). Among the 52 cases, there were 3 documented SSIs, all occurring within the colon group, resulting in an overall SSI rate of 6%. Conclusions: When evaluating compliance by bundle component and by surgeon, there was a wide variation in compliance rates. We aim to standardize processes to maximize compliance and facilitate significant reduction of variation. Moving forward, surgeon-specific dashboards will be created to educate with individualized compliance data.