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O056: The introduction of a surgical site infection prevention bundle on a nationwide scale


In 2009 a patient safety program, consisting of a 4-item surgical site infection (SSI)-prevention-bundle, was introduced in the Netherlands. The infection prevention bundle consist of: timely antibiotic prophylaxis, no preoperative surgical site hair removal, perioperative normothermia and hygiene discipline on the OR.


The aim of the SSI-bundle introduced by the safety program is to reduce the SSI-rate through creating more awareness about the importance of patient safety among hospital employees. The objective is a 90% compliance with the complete SSI-prevention bundle.


Data collection (2009-2012) was incorporated in the PREZIES surveillance network for healthcare associated infections. Compliance with the four interventions was registered separately and combined in patients, who underwent a surgical procedure present on the list of indicator procedures ( a selection of 13 procedures of 6 different specialties). Log binomial regression analysis was used to calculate relative risks (chance) on compliance, stratified by medical specialty, calendar time and participation period.


Registration of the complete bundle was around 20% by the end of 2011 (varying between 28% and 66% for the individual bundle items). Compliance with the individual bundle items increased over time: by the end of 2011, three out of four items reached a compliance greater than 75%. However, compliance with the complete bundle reached 27%.


This is the first patient safety program implementing a SSI-bundle on a nationwide scale. The objective of 90% compliance with the complete bundle was not met; although compliance increased over time, it remained low. Likewise, registration did not exceed 20%. We recommend to prolong this program, however the implementation process must be strengthened. A qualitative study is suggested to gain insight in barriers of this process.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Hopmans, T., Soetens, L., Wille, J. et al. O056: The introduction of a surgical site infection prevention bundle on a nationwide scale. Antimicrob Resist Infect Control 2 (Suppl 1), O56 (2013).

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