Surgical Site Infections in Post-Living Donor Liver Transplantation: Surveillance and Evaluation of Care Bundle Approach

Mona Wassef; Reham H. A. Yousef; Marwa Mahmoud Hussein; Mostafa A. El-Shazly; Doaa M. Ghaith

doi:10.3889/oamjms.2022.10155

Authors

Mona Wassef Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Reham H. A. Yousef Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Marwa Mahmoud Hussein Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Mostafa A. El-Shazly Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Doaa M. Ghaith Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.10155

Keywords:

Surgical site infection, Liver transplantation, Care bundle

Abstract

Background and Aim: Although implantation of a care bundle approach is well established in intensive care units (ICUs), yet its impact on reducing surgical site infections (SSI) among post living-donor-liver transplantation (LDLT) patients has not been established. Our aim is to evaluate the impact of a care bundle in reducing SSI and to detect the pattern of antibiotic resistance in LDLT. Materials and Methods: This before and after comparative study was conducted at Elmanial specialized tertiary hospital, Cairo University over a period of 3 years (January 2016 - December 2018) including 57 LDLT patients. We introduced a care bundle comprised of a group of evidence-based practices implemented together. The study was divided into three phases. All bacterial identification and antibiotic sensitivity testing were done by a Vitek 2 compact system. Results: SSIs rates were reduced significantly by 30.4% from the pre-implementation to the post implementation phase (from 13/24, 54.2% to 5/21, 23.8%, OR 0.21, CI 95%: 1.137- 0.039). This reduction went hand in hand with increase in the hand hygiene compliance from 57.3 % to 78 %, then remained sustained with a median rate of 78% in the last 6 months. Klebsiella pneumoniae 11\25 (44% of SSIs), Acinetobacter baumannii 8\25 (32% of SSIs), Escherichia coli 5\25 (20%), Pseudomonas aeruginosa 5\25 (20%) and MRSA 4\25 (16%). With predominance of XDR phenotype 14/25 (56%), followed by ESBL of gram-negative bacteria 6/25 (24%), then MRSA 4/25 (16%). Conclusion: SSIs in LDLT mandates strict implementation of comprehensive evidence-based care bundles for better patent outcome.

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