Evaluation of the Application and Efficacy of Prevention Measures for Surgical Site Infection in Elective Colorectal Surgery.

Surveillance. The VINCat Program was developed in the 2007 as the Nosocomial Infection Surveillance system in Catalonia, covering a population of seven and a half million people. The system is similar to other international reference programs, such as the National Healthcare Safety Network (NHSN), and its described in detail on the VINCat website. Hospitals carry out active and prospective standardized surveillance, and are classified according to their number of beds into three groups: group 1 (500 beds); group 2 (200-500 beds); group 3 (200 beds). The staff performing surveillance had received training in the VINCat surveillance methodology to ensure the collection of homogeneous, accurate data.

Surveillance is continued at least for 30 days after the operation. All public and private participating hospitals report data voluntarily and receive feedback once a year.

Monitoring of colorectal surgery is performed prospectively and continued until a minimum of 100 interventions per year is reached in each hospital, although some centres include all their yearly cases. Hospitals with less than 10 interventions per year are excluded. Participating hospitals record the data on an Internet-based database.

Follow-up and post-discharge surveillance. Patients are followed up by trained infection control staff. Active mandatory post-discharge surveillance is performed at least to day 30 post surgery by a multimodal approach including electronic review of clinical records (primary and secondary care), checking readmissions, checking emergency visits, and reviewing microbiological and radiological data.

Development of the colorectal surgical site infection program. In 2015, a multidisciplinary team of nurses and medical specialists from the VINCat Program, and surgeons belonging to the Catalan Society of Surgery was set up to formulate a specific bundle of SSI preventative measures for colorectal surgery. The literature for optimal care during the preoperative, intraoperative and postoperative phases was reviewed, including evidence on oral antibiotic prophylaxis and mechanical bowel preparation. Practices were chosen either by their high levels of scientific evidence or by being considered, by consensus, reasonable, associated with minimal risk, and potentially beneficial.