The no hair removal, normothermia and discipline in

The articles in this evidence
summary support the use of a bundle approach in decreasing SSI.  A bundle is a small set of EBP that improve
patient’s outcomes.  They can consist of
3-5 items. Bundles for infection control in hospitals have become important in
the United States of America after a large multicenter study was preformed
(Crolla et al.,2012).

et al. (2012) saw a reduction in the SSI rate by implementing a bundle with 4
process measures.  The items included:
perioperative antibiotic prophylaxis, hair removal before surgery,
perioperative normothermia and discipline in the operating room.  The first three are national guidelines for
reducing SSI.

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            The 7 S bundle approach developed in
a large multi-hospital system to assist with prevention of SSI (Spencer &
Christie, 2014).  It utilizes 7 measures
from safe operating room practices to using the proper dressing.  After implementation in their facilities they
had a reduction in SSI.

            Bert et al. (2017) utilized a bundle
of four items, they included: perioperative shower, the trichotomy (hair
removal), antibiotic prophylaxis, and the body temperature.  Their study showed that the use of a surgical
bundle significantly decreased the SSI risk. They go on to mention other
studies had the same effect, a reduction in the number of SSI.  They go on to discuss the application of a
new surgical bundle item, discipline in the operating room, could further
increase the effectiveness of the bundle as shown in Crolla et al. (2012)

            Koek et al. (2017) saw a
significantly lower risk for SSI when a bundle approach using four elements was
used.  The elements in this study were
antibiotic prophylaxis, no hair removal, normothermia and discipline in the
operating room.  Their study also saw a further
risk reduction with compliance of no unnecessary hair removal and discipline in
the operating room.

            Featherall et al. (2016) used 9 evidenced
based components in their study. Two of the components had no bearing on the surgical
services department.  By implementing a preventative
bundle, SSI there was a 50% reduction in SSI.  

            All five articles showed an improvement
in SSI rate when a bundle approached was used.  The common elements from the five articles included:
Using the right prophylaxis antibiotic, hair removal, maintaining normothermia,
preoperative bathing, and discipline in the operating room.

            Maintaining a high percentage of compliance
is the key to decreasing SSI using the bundle approach.  Compliance with the entire bundle of care, but
compliance with a part of the bundle, showed a significantly reduced risk of a SSI
(Koek et al., 2017).


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