***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Surgical site infections ( SSIs ) cause significant patient morbidity and increase costs . This work prospect ively examines our institutional effort to reduce SSIs through a  resident-driven quality initiative . METHODS A general surgery resident-championed , evidence d-based care bundle for patients undergoing colorectal surgery at a single academic institution was developed using attending mentorship . National Surgical Quality Improvement Program definitions for SSIs were used . Data were collected prospect ively and bundle compliance was monitored using a checklist . The primary outcome compared SSIs before and after implementation . RESULTS In the 2 years preceding st and ardization , 489 colorectal surgery cases were performed .  SSIs occurred in 68 patients ( 13.9 % SSI rate ) . Following implementation of the bundle , 212 cases were performed with 10 SSIs ( 4.7 % SSI rate , P < .01 ) . Multivariate logistic regression analysis found a decrease in superficial and overall SSIs ( odds ratio .17 , 95 % confidence interval .05 to .59 ; odds ratio .31 , 95 % confidence interval .14 to .68 ) . CONCLUSIONS These data demonstrate that  resident-driven  initiatives to improve quality of care can be a swift and effective way to enact change . We observed significantly decreased SSIs with a renewed focus on evidence -based , st and ardized patient care BACKGROUND Although evidence -based guidelines for best practice s pertaining to surgical site infection ( SSI ) prophylaxis exist , the feasibility of implementing such practice s remains to be demonstrated outside of a controlled clinical trial . This study was design ed to assess the safety and feasibility of implementing evidence -based care practice s to prevent SSIs . STUDY DESIGN A prospect i ve , double-cohort ( pre- and postintervention ) trial in elective , general surgery patients was conducted . All patients undergoing elective , major colorectal or hepatobiliary operations were enrolled . Postintervention cohort patients were exposed to new strategies to improve antibiotic administration times , perioperative normothermia rates , and  perioperative glucose control .  They were compared with the preintervention cohort , which received st and ard practice at the time . Outcomes evaluated include timing of antibiotic administration , perioperative temperatures , and postoperative glucose levels . SSI rates between cohorts were also compared . RESULTS A total of 208 patients were enrolled . The proportion of patients receiving their preoperative antibiotics within 60 minutes improved from 5.9 % to 92.6 % ( p < 0.001 ) ; perioperative normothermia rates improved from 60.5 % to 97.6 % ( p < 0.001 ) between cohorts . There was no improvement in rates of hyperglycemia . SSI rates improved but did not reach statistical significance ( 14.3 % versus 8.7 % ; p = 0.21 ) . CONCLUSIONS Implementation of evidence -based care practice s to prevent SSI is both safe and practical outside the setting of a r and omized , controlled trial . Sustained compliance remains to be demonstrated , although practice audits at our institution suggest ongoing success is possible BACKGROUND Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program ( NSQIP ) since January 2006 . Data on general and colorectal surgical site infections ( SSIs ) demonstrated a need for improvement in SSI rates . OBJECTIVE To evaluate application of a " care bundle " for patients undergoing colorectal operations , with the goal of reducing overall SSI rates . METHODS We prospect ively implemented multiple interventions , with retrospective analysis of data using the NSQIP data base . The overall , superficial , deep , and organ/space SSI rates were compared before and after implementation of this colorectal care bundle . RESULTS Between January 2006 and December 2009 , there were 430 colorectal cases in our NSQIP report with 91 infections , an overall rate of 21.16 % . Between January 2010 , when the colorectal care bundle was implemented , and June 2011 , there were 195 cases and 13 infections , a 6.67 % overall rate . The absolute decrease of 14.49 % is significant ( p < 0.0001 ) . The rate of superficial SSI decreased from 15.12 % to 3.59 % ( p < 0.0001 ) . The rates for deep and organ/space SSI also showed a decrease ; however , this was not statistically significant . The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation ( fiscal year 2010 ) . CONCLUSIONS Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases . By instituting a care bundle composed of core and adjunct strategies , we significantly decreased our rate of colorectal SSIs PURPOSE : The primary goal of the Surgical Care Improvement Project is to improve quality of care by implementing evidence -based health care practice s that prevent surgical complications . This study was design ed to test the hypothesis that an increase in compliance with quality process measures decreases the rate of surgical site infections in patients undergoing colorectal surgeries . METHODS : A multidisciplinary task force implemented and monitored compliance with individual quality measures in patients undergoing elective colorectal resections at a tertiary institution . Individual compliance rates and infections were collected prospect ively and review ed monthly . For data analysis , patients were assigned to 2 consecutive 14-month periods : period A ( April 1 , 2006 to May 31 , 2007 ) and period B ( June 1 , 2007 to July 31 , 2008 ) . Comparisons between periods were performed to determine the association of compliance with process measures and outcomes in infections . RESULTS : A total of 491 consecutive patients were treated during the study periods ( period A : n = 238 ; period B : n = 253 ) . There were no statistically significant differences in patient characteristics , diagnoses , or surgical procedures between periods . Compliance with all process measures significantly increased within periods except for perioperative glucose control . Global compliance ( compliance with all measures per patient ) significantly improved from period A to B ( 40%–68 % , respectively ; P < .001 ) . In total , 99 patients ( 19 % ) developed surgical site infections ( period A , 18.9 % ; period B , 19.4 % ) . CONCLUSION : An increase in compliance with the Surgical Care Improvement Project aim ed to prevent surgical site infections does not translate into a significant reduction of surgical site infections in patients undergoing colorectal resections Introduction Surgical site infection ( SSI ) can be as high as 30 % in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality . The aim of this study is to evaluate the impact of a set of simple preventive measures that have result ed in a reduction in surgical site infection in colorectal surgery . Applied method Prospect i ve study with two groups of patients treated in the colorectal unit of the “ Clinico Universitario Lozano Blesa ” hospital in Zaragoza . One group was subject to our measures from February to May 2015 . The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented . Results One hundred forty-nine patients underwent a major colorectal surgical procedure . Seventy ( 47 % ) belonged to the control group and were compared to the remaining 79 patients ( 53 % of the total ) , who were subject to our treatment bundle in the period tested . Comparing the two groups revealed that our set of measures led to a general reduction in SSI ( 31.4 vs. 13.6 % , p = 0.010 ) and in superficial site infection ( 17.1 vs. 2.5 % , p = 0.002 ) . As a consequence , the postoperative hospital stay was shortened ( 10.0 vs. 8.0 days , p = 0.048 ) . However , it did not , the number of readmissions nor the re-operation rate . SSI was clearly related to open surgery . Conclusions The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay OBJECTIVE To assess the effectiveness of a protocol for prevention of  surgical site infection ( SSI ) in colorectal surgery . PATIENTS AND METHODS Evaluation of 2 cohorts of patients undergoing colon and rectal surgery in a tertiary public hospital : A historical cohort ( 2008 - 2011 ) and a prospect i ve one ( after the implementation of the program in 2012 ) . The main measures established were : Adequacy of preoperative antimicrobial prophylaxis , maintaining patient normothermia and appropriate glove change during the intervention . Comparability of the two cohorts was determined by a bivariate analysis of age , sex , NNIS index , ASA index , surgical time , perioperative transfusion , diagnosis , diabetes and renal failure . RESULTS We assessed 342 patients ( 256 underwent colon surgery and 86 rectal surgery )  , divided into 2 cohorts : prior period ( 218 ) , and post-implementation period ( 124 ) . The cumulative incidence of SSI in the first cohort was 27.5 % ( 95 % CI , 21.6- 33.4 ) , and in the post-intervention cohort 16.9 % ( 95 % CI , 10.3 - 23.5 , P=.03 ) . Postoperative mortality was 9.2 % ( 95 % CI , 5.4 - 13 ) in the first cohort and 3.2 % ( 95 % CI , 0.1 - 6.3 ) in the post-intervention cohort ( P=.04 ) . The inadequacy of prophylaxis decreased from 37.4 % ( 95 % CI , 30.4 - 44.6 ) to 18.9 % ( 95 % CI , 11.9- 26.1 ) ( P=.001 ) . CONCLUSION A significant decrease in the frequency of SSI , post-surgical mortality and inadequate antimicrobial prophylaxis is verified after the implementation of a protocol in colorectal surgery OBJECTIVE To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis ( RAP ) of 30 - 74 minutes before skin incision compared to the World Health Organization ( WHO ) st and ard of 0 - 60 minutes . DESIGN Prospect i ve study on timing of routine antimicrobial prophylaxis in 2 different time periods . SETTING Tertiary referral university hospital with 30,000 surgical procedures per year . METHODS In all consecutive vascular , visceral , and trauma procedures , the timing was prospect ively recorded during a first time period of 2 years ( A ; baseline ) and a second period of 1 year ( B ; after intervention ) . An intensive intervention program was initiated after baseline . The primary outcome parameter was timing ; the secondary outcome parameter was surgical site infection ( SSI ) rate in the subgroup of patients undergoing cholecystectomy/colon resection . RESULTS During baseline time period A ( 3,836 procedures ) , RAP was administered 30 - 74 minutes before skin incision in 1,750 ( 41.0 % ) procedures ; during time period B ( 1,537 procedures ) , it was administered in 914 ( 56.0 % ; [ Formula : see text ] ) . The subgroup analysis did not reveal a significant difference in SSI rate . CONCLUSIONS This bundle of interventions result ed in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO st and ard BACKGROUND High rates of inappropriate use of prophylactic antibiotics in surgery continue to be reported in the literature , with many institutions design ing interventions aim ed at improving prescription . This study evaluates the surgical arm of a clinician-focused educational antimicrobial stewardship program implemented in February 2014 at Blacktown Hospital , Australia . METHODS A before-after analysis of the surgical antibiotic prophylaxis intervention  was conducted at Blacktown Hospital , New South Wales , Australia . Two hundred abdominal general surgical patients were selected via simple r and om sampling and categorized into pre-intervention ( n = 100 ) and post-intervention ( n = 100 ) groups . Antibiotic prophylaxis regimens were compared with the Australian guideline , Therapeutic Guidelines : Antibiotic ( v14 ) with respect to drug choice , dosage , timing of administration , and duration of administration . RESULTS Overall adherence rates in the pre- and post-intervention periods were 18 % and 15 % respectively , demonstrating no substantial change ( p = 0.568 ) . No patients in either group were administered antibiotics without an appropriate indication . There were no substantial decreases in error rates across any category , including drug choice , dosage , timing of administration , duration of administration , or re-dosing . The apparent decrease in the rate of inappropriate broad-spectrum cephalosporin usage was not statistically significant ( 29.3 % vs. 18.8 % ; p = 0.16 ) . CONCLUSIONS The educational intervention studied demonstrated no substantial change to overall adherence . Given the frequent failure of such interventions , stronger and more directly m and ated adoption of prescribing guidelines is recommended for surgical services . Future consideration should be given to focused computer-based solutions , integrated with electronic medical 
    Output:
    
In SSI prevention in abdominal surgery , mostly st and ard bundles of implementation interventions are applied .
While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results , use of st and ard interventions such as audit and feedback , organizational culture , monitoring , reminders , and education at least does not seem to represent preventive mal practice .