Table 3. Evidence of Included Studies that Met EPOC Criteria (n=8) Author, Year, Country Design, Setting, Population (no.) Surgical Specialty


Aiken 2013 Kenya/Low


TSA


Single hospital Adults (3,343)


Multiple


Interventions


Ed: Education materials Ex: Policy Ev: Surveillance, data feedback, audit


IPC Measures SAP policy


Compliance SSI Def.


SSI Outcome


Increase CDC 1999 Decreased for superficial SSI only: Clean, clean-contaminated Pre: 69/1,130 (6.1%) Post: 83/2,046 (4.1%) P=.01


Contaminated and dirty: Pre: 10/76 (13.2%) Post: 17/91 (2.2%) P=.006 Total SSI (P values not provided): Clean, clean-contaminated: Pre: 82/1,130 (7.3%) Post: 102/2,046 (5%) Contaminated and dirty: Pre: 18/76 (23.7%) Post: 17/91 (18.7%)


Anthony 2011 United States /High


RCT Single Adults (211)


Colorectal Ex: Bundles


No mechanical bowel prep, use of pre-/ intraoperative warming, increased oxygen during and after, reduction of intravenous fluid


Hadley 2010 United States /High


Rao 2011 United States /High


Schweizer 2015 United States


CBA Single Adults (2,058)


CBA Single Adults (4,310)


TSA


Multiple hospitals Adults (42,534)


Toltzis 2014 United States


TSA


Multiple hospitals Pediatrics


Multiple


En: Administrators, transparency of teams without liability, leadership teams, teleconferences with other teams to share lessons learned


Ex: Bundle


Van Kasteren 2005 Netherlands


Weinberg 2001 Colombia


TSA


Multiple hospitals Mixed population (3,813)


TSA


Multiple hospitals Adults (16,464)


OB/GYN Multiple


Ex: Policy Ed: Educational sessions Ev: Audits and data feedback


En: Leadership, teamwork/ multi-disciplinary


Ed: Training Ex: CQI tools and principle Ev: Data feedback, accountability


SAP


SAP policy, hair removal, skin prep


No change CDC 1999 No change Pre: 5.4% (95% CI: 4.3–6.5)> Post: 4.6% (95% CI: 3.6–5.4)


Increase CDC 1992 Decrease Hospital A: P < .001 Hospital B: P=.04


Orthopedic Orthopedic Multiple


Ex: Screening and decolonization protocol


Ed: Patient education Ex: Screening protocol


Ex: Bundle


Mupirocin and chlorohexidine Antibiotic choice


Screening for S. aureus and decolonization, targeted prophylaxis


Prohibition of razor, chloraprep use, SAP


NR CDC 2008 Increase


Intervention: 45/100 (45%) Control: 24/97 (25%) P=.004


Mupirocin and vancomycin Increase CDC 2008 Decrease 1.45 vs 1.28 P=.809 Increase


NR Decrease SSI rates: Pre: 2.7% Post: 1.2% P=.009


Increase CDC 2013 Decrease (S. aureus SSI) Pre: 101/28,218 Post: 29/14,316 RR=0.58 CI=0.37–0.92


Increase CDC 2008 Decrease Pre: 4.48/100 surgical procedures Post: 1.89/100 surgical procedures P value not provided.


Note. EPOC, Effective Practice and Organization of Care; IPC, infection prevention control; SSI, surgical site infection; Def, definition; TSA, time-series analysis; Ed, educate; Ex, execute; Ev, evaluate; SAP, surgical antimicrobial prophylaxis; CDC, Centers for Disease Control; RCT, randomized controlled trial; NR, not reported; CBA, controlled before-after; CI, confidence interval; En, engage; OB/GYN, Obstetrics and Gynecology; CQI, continuous quality improvement.


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Promise T. Ariyo et al


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