Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt

Figures & data

Figure 1 Chromogenic media (ChromID OXA-48) for detection of OXA-48-type carbapenemase-producing Enterobacteriaceae.

Figure 2 CHROMagar Acinetobacter for detection of MDR A. baumannii.

Table 1 Operative Data for All Patients Who Had Surgery at the SICU During the Phase I and Phase III. Data are Presented as Frequencies (Percent)

	Phase I (Total 177)		Phase III (Total 93)		P-value
	Count	%	Count	%
Type of Operation
Head and neck	4	2.2%	1	1.1%
Abdominal	103	58.1%	51	54.8%
Vascular	27	15.3%	18	19.4%
Neurosurgery	17	9.6%	11	11.8%
Orthopedic	12	6.8%	8	8.6%
Urology	5	2.8%	3	2.1%
Cardiothoracic	5	2.8%	0	0.0%
Plastic	2	1.1%	1	1.1%
Obstetrics and Gynecology	1	0.6%	0	0.0%
Ophthalmic	1	0.6%	0	0.0%
Abdominal and Vascular	0	0.0%	1	1.1%
Class of wound
Clean	66	37.5%	31	33.7%	0.063
Clean contaminated	76	43.2%	36	39.1%
Contaminated	24	13.6%	23	25.0%
Dirty	10	5.7%	2	2.2%
Duration of surgery
One hour	52	29.5%	21	22.8%	0.175
Two hours	57	32.4%	26	28.3%
Three hours	61	34.7%	37	40.2%
More than three hours	6	3.4%	8	8.7%
Antibiotic prophylaxis	96	54.2%	86	92%*	<0.001
Devices
Urinary catheter	107	60.5%	62	66.7%	0.316
Ventilator	105	59.3%	37	39.8%*	0.001
Drain	103	58.1%	51	54.8%	0.597

Note: *Denotes significant difference between both groups.

Table 2 Details of Surgical Site Infection in Phase I and III

	Phase I (Total 49/177)		Phase III (Total 14/93)		P-value
	Count	%	Count	%
SSI Rate	49	27.6%	14	15.0%	<0.001
Type of SSI
Deep	22	45.8%	7	53.8%	0.837
Deep with organ	25	52.1%	6	46%
Superficial	1	2.1%	0	0.0%
Causative organism
Klebsiella pneumoniae	17	34.7%	4	30.8%	0.108
Mixed Colonizers	11	22.4%	0	0.0%
Acinetobacter baumannii	7	14.3%	5	38.5%
No growth	6	12.2%	1	7.7%
Methicillin-resistant Staph aureus (MRSA)	3	6.1%	0	0.0%
Pseudomonas aeruginosa	2	4.1%	2	15.4%
Providencia stuartii	1	2.0%	0	0.0%
Proteus vulgaris	1	2.0%	0	0.0%
Staph aureus	1	2.0%	0	0.0%
Enterococci faecalis	0	0.0%	1	7.7%
Pattern of resistance
Extended spectrum B lactamase (ESBL)	3	6.1%	1	7.1%	0.119
AmpC	6	12.2%	1	7.1%*	0.007
AmpC and ESBL	1	2.0%	0	0%	0.345

Note: *Denotes significant difference between both groups.

Table 3 The Table Shows the Decolonization Rate in the Phase III

Screening		First Sample (Total 77)		Second Sample (Total 68)		P-value
		Count	%	Count	%
Acinetobacter MDR screening (nasal and axillary)	Yes	33	42.8%	11	16.1%	0.005
		First sample (Total 71)		Second sample (Total 62)		P-value
Acinetobacter MDR screening (anal)	Yes	45	63.3%	21	33.87%	0.007
Screening		First sample (Total 80)		Second sample (Total 54)		P-value
OXA 48 MDR screening	Klebsiella pneumoniae	26	32.5%	6	11%	0.004
	No growth	40	50%	42	77.7%	0.001
	E. coli	7	8.7%	6	11%	0.652
	Both	7	8.7%	0	0%	0.001

Table 4 Antibiotics Used in the Treatment of Patients in Phases I and III

	Phase I Total (177)		Phase III Total (93)		P-value
	Count	%	Count	%
Imipenem	108	61%	36	38.7%*	0.011
Vancomycin	90	51.0%	6	6.5%*	< 0.001
Cefepime	7	4.0%	32	34.4%*	< 0.001
Cefoperazone/sulbactam	4	2.0%	0	0.0%	0.345
Clindamycin	14	8.0%	6	6.5%	0.737
Piperacillin/tazobactam	7	4.0%	5	5.4%	1
Metronidazole	0	0.0%	11	11.8%*	0.016
Tigecycline	0	0.0%	2	2.2%	0.545
Meropenem	7	4.0%	14	15.1%*	0.049
Fluconazole	4	2.0%	6	6.5%	0.422
Teicoplanin	0	0.0%	4	4.3%	0.298
Ceftriaxone	7	4.0%	1	1.1%	0.274

Note: *Denotes significant difference between both groups.

Figure 3 Compliance with bundle components (total 93 patients).