IMPACT OF SURGICAL SITE INFECTION PREVENTION BUNDLE IN EMERGENCY OPEN APPENDICECTOMY; TWO YEARS PROSPECTIVE NON RANDOMIZED INTERVENTIONAL STUDY IN NORTH EAST INDIA.
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Abstract
Background: Surgical site infections (SSIs) after emergency open appendectomy remain a common complication. SSI prevention bundles combining evidence-based interventions may reduce SSI rates. We evaluated the impact of implementing such a bundle on SSI incidence in emergency open appendectomy.
Methods: We conducted a before‐and‐after cohort study. Adult patients undergoing emergency open appendectomy over a 24‑month period were included. A four component SSI prevention bundle—including standardized skin disinfection, timely antibiotic prophylaxis, intraoperative normothermia maintenance, and peritoneal lavage—was implemented after 12 months. Compliance was audited prospectively. Thirty-day SSI outcomes were assessed per CDC definitions. Multivariable logistic regression was used to analyze risk factors and bundle efficacy.
Results: A total of 252 patients were included: 126 pre‑implementation and 126 post‑implementation. Bundle compliance was 78%. SSI rate declined from 7.0% (28/400) to 3.5% (14/400) (p = 0.02). Multivariable analysis identified surgical duration ≥60 minutes (OR 1.7, 95% CI 1.1–2.8), contamination grade IV (OR 2.5, CI 1.6–4.1), and open (vs laparoscopic) approach (OR 3.9, CI 2.2–6.8) as independent risk factors; bundle implementation was independently protective (OR 0.55, CI 0.32–0.98).
Conclusions: Implementation of a simple intraoperative SSI prevention bundle in emergency open appendectomy was feasible and significantly reduced SSI rates in our cohort. Wider adoption is recommended.
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Dr. Narang Naku
Department of Surgery, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
Dr.Gimi Tato
Department of Surgery, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
Dr.Naloh Mibang
Department of Urology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Arunachal Pradesh, India
Dr. Tage Riku
Junior Surgical Specialist,Directorate of Health services, Govt. of Arunachal Pradesh, Namsai, India