The articles in this evidence
summary support the use of a bundle approach in decreasing SSI. A bundle is a small set of EBP that improve
patient’s outcomes. They can consist of
3-5 items. Bundles for infection control in hospitals have become important in
the United States of America after a large multicenter study was preformed
(Crolla et al.,2012).
et al. (2012) saw a reduction in the SSI rate by implementing a bundle with 4
process measures. The items included:
perioperative antibiotic prophylaxis, hair removal before surgery,
perioperative normothermia and discipline in the operating room. The first three are national guidelines for
The 7 S bundle approach developed in
a large multi-hospital system to assist with prevention of SSI (Spencer &
Christie, 2014). It utilizes 7 measures
from safe operating room practices to using the proper dressing. After implementation in their facilities they
had a reduction in SSI.
Bert et al. (2017) utilized a bundle
of four items, they included: perioperative shower, the trichotomy (hair
removal), antibiotic prophylaxis, and the body temperature. Their study showed that the use of a surgical
bundle significantly decreased the SSI risk. They go on to mention other
studies had the same effect, a reduction in the number of SSI. They go on to discuss the application of a
new surgical bundle item, discipline in the operating room, could further
increase the effectiveness of the bundle as shown in Crolla et al. (2012)
Koek et al. (2017) saw a
significantly lower risk for SSI when a bundle approach using four elements was
used. The elements in this study were
antibiotic prophylaxis, no hair removal, normothermia and discipline in the
operating room. Their study also saw a further
risk reduction with compliance of no unnecessary hair removal and discipline in
the operating room.
Featherall et al. (2016) used 9 evidenced
based components in their study. Two of the components had no bearing on the surgical
services department. By implementing a preventative
bundle, SSI there was a 50% reduction in SSI.
All five articles showed an improvement
in SSI rate when a bundle approached was used. The common elements from the five articles included:
Using the right prophylaxis antibiotic, hair removal, maintaining normothermia,
preoperative bathing, and discipline in the operating room.
Maintaining a high percentage of compliance
is the key to decreasing SSI using the bundle approach. Compliance with the entire bundle of care, but
compliance with a part of the bundle, showed a significantly reduced risk of a SSI
(Koek et al., 2017).