American Surgical Association

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Impact of a Novel Preoperative Patient-Centered Surgical Wellness Program
Kristen Kelley, Alyssa D. Fajardo, Nancy M. Strange, Carol Harmon, Kim A. Pawlecki, Nikki Walke, William A. Wooden, Thomas J. Birdas, Larry H. Stevens, Grace S. Rozycki, C. Max Schmidt
Indiana University Health, Indianapolis, IN

OBJECTIVE(S): Healthcare associated infections (HAI) threaten patient outcomes and are a significant burden to the healthcare system. Preoperative wellness efforts may significantly decrease the risk of HAI. The objective of this project was to implement and evaluate a novel, preoperative wellness intervention with input from patients, clinicians, and other key stakeholders.
METHODS: 8,010 patients (wellness group) received a wellness bundle in a roller bag during preoperative screening at an urban academic medical center. The wellness bundle consisted of chlorhexidine bath solution, topical mupirocin for the nostrils, an incentive spirometer, immunonutrition supplements, and smoking cessation information. Study staff performed structured patient interviews, observations, and standardized surveys at key intervals throughout the perioperative period. Statistics compare HAI outcomes of patients in the wellness program to a non-intervention group using the Fisher's Exact Test.
RESULTS: Patients in the non-intervention and wellness groups were similar in demographics, co-morbidity, and type of operations. Compliance with each element was high, with 65% of patients complying with the chlorhexidine bath, 74% for mupirocin, 62% for spirometer, and 61% for immunonutrition. The wellness group had statistically significant reductions in surgical site infections (SSI), Clostridium difficile (CDI), and catheter associated urinary tract infections (CAUTI) (table 1).
CONCLUSIONS: A novel, preoperative, patient-centered wellness program dramatically improved outcomes for surgical patients by reducing postoperative infectious complications.
Table 1: Preoperative Wellness Program HAI Outcomes

HAINon-Intervention Group (9148 patients; 01/07/2014-12/31/2015)Wellness Group (8010 patients; 01/01/2016-07/31/2017)P value
SSI51 (0.56%)22 (0.27%)0.0046
CDI78 (0.85%)34 (0.42%)0.0006
CAUTI27 (0.30%)6 (0.07%)0.0008
VAE14 (0.15%)6 (0.07%)0.1785
CLABSI7 (0.08%)3 (0.04%)0.3544

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