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A comprehensive unit-based safety program for the reduction of surgical site infections in plastic surgery and hand surgery

Published online by Cambridge University Press:  14 October 2019

Laura Lenherr Ramos
Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
Rainer Weber
Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
Hugo Sax
Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
Pietro Giovanoli
Department of Plastic Surgery and Hand Surgery, University Hospital and University of Zurich, Zurich, Switzerland
Stefan P. Kuster*
Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
Author for correspondence: Stefan P. Kuster MD, Email:



To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery.


Uncontrolled before-and-after study.


Department of plastic surgery and hand surgery of a tertiary-care teaching hospital.


Patients undergoing surgery between January 2016 and April 2018.


A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis.


Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%–65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31–5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed.


This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.

Original Article
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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