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July 12, 2026Infection Prevention in PracticeOpen Access

SSI care bundle linked to ~44% lower surgical site infection rate after emergency laparotomy.

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Why the study?

Surgical site infection is common after emergency laparotomy, yet most hospitals are unaware of their rates, and most studies have focused on elective surgery.

Does an SSI care bundle reduce surgical site infection rates in patients undergoing emergency laparotomy?

Population

176 patients pre-intervention and 501 patients post-intervention undergoing emergency laparotomy

Comparison

SSI care bundle implementation vs pre-intervention baseline

Design

Prospective quality improvement study with continuous SSI surveillance

Follow-up

Over four years

Key result

Implementation of an SSI care bundle for patients undergoing emergency laparotomy reduced the overall surgical site infection rate from 32.1% to 18.1% (p=0.002).

Authors

CSCara SwainOBO. BrewsterMQMarcus Quinn

Discussion

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Overview

May support care bundle use to reduce SSI after emergency laparotomy; leaves open need for randomized confirmation.

Key Points

  • To establish a reliable method for measuring post-emergency laparotomy SSI rates and evaluate a care bundle to reduce SSI.
  • Prospective quality improvement study with continuous SSI surveillance over four years.
  • Evaluation of a care bundle including chlorhexidine preparation, wound protector, and antibiotic protocol.
  • Analysis of SSI rates before and after implementation of the care bundle.
  • Pre-intervention SSI rate was 32.1%, reducing to 18.1% post-intervention (p=0.002).
  • Post-intervention SSI rates: 11.8% for clean wounds (p=0.275), 15.1% for clean-contaminated (p=0.121), 25.6% for dirty wounds (p=0.021).
  • Overall 44% reduction in post-EL SSI observed.

Study Design

Type

Observational (n=677)

Multicenter

No

Structured PICO

Does an SSI care bundle reduce surgical site infection rates in patients undergoing emergency laparotomy?

P
Population
677 patients undergoing emergency laparotomy evaluated over four years before and after the implementation of a surgical site infection care bundle.
I
Intervention
SSI care bundle (2% chlorhexidine skin preparation, second antibiotic dose after 4 hours, use of a wound protector, antibacterial sutures, glove change and povidone iodine wound wash)
C
Comparator
Pre-intervention standard care
O
Outcome
Surgical site infection (SSI) ratehard clinical

Main Result

Effect estimate: 44% reduction

Absolute Event Rate: 18.1% vs 32.1%

p-value: p=0.002

Implementation of a structured SSI care bundle significantly reduces surgical site infections in patients undergoing emergency laparotomy.

Limitations

  • Measuring SSI after emergency laparotomy is challenging due to high mortality, use of laparostomy, and longer length of stay.
  • Implementing behaviour change in a diverse group of surgeons in the emergency setting during a pandemic was difficult.
  • Measuring SSI after emergency laparotomy is challenging due to high mortality, use of laparostomy, and longer length of stay
  • Implementing behaviour change in a diverse group of surgeons in the emergency setting, during a pandemic in an NHS hospital, was difficult

Cite This Study

Swain et al. (2026) conducted an observational in Emergency laparotomy (n=677). SSI care bundle vs. Pre-intervention (baseline care) was evaluated on Overall surgical site infection (SSI) rate (44% reduction, p=0.002). Implementation of an SSI care bundle for patients undergoing emergency laparotomy reduced the overall surgical site infection rate from 32.1% to 18.1% (p=0.002).

synapsesocial.com/papers/6a534ff4985393734a594cd2https://doi.org/10.1016/j.infpip.2026.100566
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