The articles in this evidencesummary support the use of a bundle approach in decreasing SSI.
A bundle is a small set of EBP that improvepatient’s outcomes. They can consist of3-5 items. Bundles for infection control in hospitals have become important inthe United States of America after a large multicenter study was preformed(Crolla et al.,2012). Crollaet al. (2012) saw a reduction in the SSI rate by implementing a bundle with 4process 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 forreducing SSI.
The 7 S bundle approach developed ina large multi-hospital system to assist with prevention of SSI (Spencer , 2014). It utilizes 7 measuresfrom safe operating room practices to using the proper dressing. After implementation in their facilities theyhad a reduction in SSI. Bert et al. (2017) utilized a bundleof four items, they included: perioperative shower, the trichotomy (hairremoval), antibiotic prophylaxis, and the body temperature. Their study showed that the use of a surgicalbundle significantly decreased the SSI risk. They go on to mention otherstudies had the same effect, a reduction in the number of SSI. They go on to discuss the application of anew surgical bundle item, discipline in the operating room, could furtherincrease the effectiveness of the bundle as shown in Crolla et al.
(2012)study. Koek et al. (2017) saw asignificantly lower risk for SSI when a bundle approach using four elements wasused. The elements in this study wereantibiotic prophylaxis, no hair removal, normothermia and discipline in theoperating room. Their study also saw a furtherrisk reduction with compliance of no unnecessary hair removal and discipline inthe operating room. Featherall et al.
(2016) used 9 evidencedbased components in their study. Two of the components had no bearing on the surgicalservices department. By implementing a preventativebundle, SSI there was a 50% reduction in SSI. All five articles showed an improvementin 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 complianceis the key to decreasing SSI using the bundle approach. Compliance with the entire bundle of care, butcompliance with a part of the bundle, showed a significantly reduced risk of a SSI(Koek et al., 2017).