Implementation of a standardized intervention program to reduce surgical site infections after gynecologic cancer surgery

Introduction:

Surgical site infections after laparotomy are commonly observed in women who underwent major gynecologic cancer surgery. Superficial dehiscences require conservative treatment, whereas deep defects may indicate negative pressure wound therapy (VAC therapy). The implementation of a standardized intervention program was reported to reduce the incidence of wound healing disorders.

Methods:

We have implemented the following standardized intervention program: Chlorhexidindigluconat 4% shower twice before surgery, bowel preparation with oral antibiotics (Paromomycin 1 g and Metronidazole 400 mg twice the night before surgery), change of instruments/gloves for wound closure, Chlorhexidindigluconat 4% shower 24 – 48 hours postoperatively, hand-disinfection agent readily available. We retrospectively examined data from a total of 171 patients who underwent surgery by laparotomy due to endometrial, ovarian, fallopian tube or peritoneal cancer from January 2014 through January 2018.

Results:

In the pre-intervention cohort (n = 110) surgical site infections occurred in 34 (31%) patients; in 23 (21%) of these VAC therapy was performed. In the control group (n = 61) surgical site infections occurred in 14 (23%), and 9 patients (15%), respectively. Larger cohorts are required to proof significance.

Conclusion:

By implementation of a prevention program for surgical site infections, a reduction of wound healing disorders after laparotomy was achieved. It may therefore reduce the overall morbidity as well as days and costs of hospitalization and delays in subsequent cancer therapies.