eP437 - The Effect of Clean Closure Protocol on Colorectal Surgical Site Infection Rates

Purpose/Background: Surgical site infections (SSIs) have many implications for patient care. Because of this, SSI reduction has been targeted by quality improvement initiatives at many institutions. Cases with a higher wound class, such as colorectal surgery, have inherently higher postoperative SSI rates reported in the literature from 15% to over 30%. Different protocols have been implemented in attempt to reduce SSI rates. While no specific intervention has been shown to decrease SSI rates, the combination of multiple interventions to minimize contamination has been shown to decrease SSI rates in colorectal surgery. The primary objective of this study is to evaluate the utilization rate of a recently implemented clean closure protocol (CCP) in our hospital system and its effectiveness in reducing SSIs in colorectal surgeries. The secondary aim is to compare the utilization and effectiveness of the CCP between minimally invasive surgeries and open surgeries.Methods/Interventions: We performed a retrospective review of elective colorectal surgeries for benign and malignant disease performed on adult patients >18 years old between April 2021 and December 2021 at a single institution. All patients received a mechanical bowel preparation. CCP is defined by use of 1) wound protector, 2) antibiotic irrigation with 500cc normal saline containing 240mg gentamicin and 600mg clindamycin for 3 minutes, 3) usage of a clean set of instruments, gowns, drapes for abdominal closure, 4) irrigation of skin and soft tissue with additional antibiotic saline solution. Partial compliance was defined as utilization of at least one portion of CCP, but not all 4 components of the CCP. The cases were analyzed for CCP compliance and the presence or absence of SSIs. Univariate analysis was performed using Chi-squared tests.Results/Outcomes: 164 cases were included in the study, of which 69 were minimally invasive and 95 were open surgeries. There were four (2.4%) SSIs reported during this study period. There was a trend towards increased CCP compliance over this study period. There was no significant difference in CCP compliance in the MIS cohort (65.6% v. 54%, p = 0.23). There was a statistically significant increase in utilization of the CCP over time in the open surgery subgroup (65.2% v. 83.7%, p = 0.006). When comparing the first half to the second half of the study period, there was a statistically significant decrease in overall SSI rates (3.8% v. 1.2%, p < 0.001). This decrease was seen in both the minimally invasive subgroup (3.1% v. 0%, p < 0.001) and the open surgery subgroup (4.3% v. 2.0%, p < 0.001). There was no statistically significant difference in SSI rate between MIS and open surgery (1.4% v. 3.2%, p = 0.27). There was no statistically significant correlation between the CCP utilization rate and SSI rate (p = 0.77).Conclusion/

Discussion: There was a significantly increased utilization of CCP, particularly in the open subgroup, during our study period. A decrease in SSI rates was observed over time in the open and minimally invasive subgroups, however this could not be directly attributed to the increased CCP utilization given our low SSI rates overall and relatively small sample size. The results of this study warrant ongoing analysis with a larger data set over a longer period.Figure 1 - Clean Closure Protocol Compliance Rates