Surgical Site Infection (SSI) Prevention Bundle to Reduce the Incidence of Post-Mastectomy SSI Among Breast Cancer Patients at an Academic Medical Center: Effectiveness and Cost Consequence Analysis.

Abstract

Introduction: Surgical site infections (SSI) are common healthcare-associated infections. The incidence of post-mastectomy SSI varies from 1% to 30%, which is significantly higher compared to the expected incidence of 2% for clean surgeries. This study aimed to assess the effectiveness and the cost implications of implementing a SSI prevention bundle as well as identify the risk factors associated with SSI among breast cancer patients undergoing mastectomy at an academic medical center.

Method: A pre-post intervention study was conducted at the Universiti Malaya Medical Center (UMMC), a tertiary teaching hospital in Malaysia. The pre-intervention baseline SSI rates were obtained retrospectively (July 2015 to June 2016), and the post-implementation SSI rates were collected prospectively (July 2017 and September 2018). The implementation of the SSI prevention bundle was based on the quality implementation framework. The SSI prevention bundle consists of preoperative, intraoperative, and postoperative evidence-based preventive measures adapted from the Global Guidelines for the Prevention of SSI by the World Health Organization.

Results: The SSI rate dropped by 70% after implementing the SSI prevention bundle. Only 6.9% (11 out of 159 cases) developed SSI after the implementation of the SSI prevention bundle, compared to 23.1% (27 out of 117 cases) before its implementation. The mean cost per patient treated for SSI in the outpatient clinic setting (n = 29) was MYR904 ± 991 [USD $217 ± 238] while the mean cost per patient was MYR13,059 ± 5475 [USD $3134 ± 1315] for those treated within the inpatient setting (n = 9). The additional implementation cost of the SSI prevention bundle was MYR48 [USD $12] per patient. Multivariate logistic regression analysis revealed that patients undergoing surgery without the SSI bundle (OR: 5.28, 95% CI:1.76-15.82, p value = 0.003) and obesity (OR: 6.34, 95% CI:1.44-30.00, p value = 0.02) were significant risk factors of SSI.

Conclusion: The SSI prevention bundle was effective in reducing the incidence of SSI amongst breast cancer patients undergoing mastectomy, with improved patient outcomes and cost-savings. Continuous monitoring within departmental quality key performance indicators and hospital infection control programmes will ensure sustained outcomes in the prevention of SSI.