George is a Senior Lecturer in the Health Services Research Unit, having joined the unit in 2021. He is also a Consultant Colorectal and General Surgeon in Aberdeen Royal Infirmary. Before moving to HRSU, he was a SCREDS clinical lecturer in the Rowett Institute of the University of Aberdeen.

His clinical training started in the University of Edinburgh where he undertook his undergraduate training, followed by his surgical training in the North and North East of Scotland. During his training, he took time out to undertake a PhD in Mucosal Immunology studying the lymphocytes in the small and large intestine that are key to maintaining health of these organs.

His current research interests are in describing and characterising Emergency General Surgery, assessing outcomes in colorectal cancer management (short and long term) and medical education.

Presentation at the WReN Scientific Meeting, Glasgow, May 2022

Reducing surgical site infection rates in colorectal surgery – A quality improvement approach to implementing a comprehensive bundle

Objectives

After attending this session, persons will be able to:

• Discuss a QA approach to improving clinical outcomes
• Observe improvements demonstrated by our approach
• Discuss potential new trials in this field
• Appreciate the importance of a team approach
• Identify strengths in QA in research

Abstract

Aim – Surgical site infections (SSIs) are a preventable cause of morbidity following surgical procedures. Strategies to reduce rates of SSI must address pre-, peri- and postoperative factors and multiple interventions can be combined into ‘bundles’. Adoption of these measures can reduce SSIs, but this is dependent on high levels of compliance.

Method – This is a single-centre prospective cohort study. All elective colorectal procedures from 2011 until 2018 (inclusive) were included. The primary outcome was inpatient SSI. A multimodal bundle was implemented using quality improvement methodology. The bundle was altered during the timeframe of the study to optimize outcomes. Data were analysed by interrupted time series analysis assessing points at which the bundle was altered.

Results – In the study period, 1075 elective colorectal procedures were performed. Prior to the introduction of the colorectal SSI bundle, the SSI rate was 16.4%. During the implementation period (2013–2015), the overall rate of SSI fell from 15.9% to 9.4%, with the most significant reduction being in superficial SSI, from 8.6% to 4.7%. In the postimplementation period from 2015–2018, there was a further reduction in the overall rate of SSI (5.1%). In 2018, there were 87 consecutive cases without infection.

Conclusion – A successful reduction in the rate of SSI following elective colorectal surgery can be achieved by adopting a comprehensive perioperative bundle. This is complemented by a process of continuous measurement and evaluation. The current bundle has achieved a significant reduction in superficial SSI.