Surgical site infection prevention bundle: changes in staff nurses’ practices and SSI outcomes

Sumana Bhunia; Amita Paul; Narendra Kumar Tiwary

doi:10.18203/2394-6040.ijcmph20263597

Authors

Sumana Bhunia Department of Nursing, Mansarovar Global University, Bhopal, Madhya Pradesh, India
Amita Paul Faculty of Nursing Science, Mansarovar Global University, Bhopal, Madhya Pradesh, India
Narendra Kumar Tiwary Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263597

Keywords:

Surgical site infection, Bundle care, Nursing practice, Infection prevention, Postoperative patients, Quality improvement

Abstract

Background: Surgical site infection (SSI) remains an important postoperative problem, and prevention depends on consistent care. This study examined changes in nurses’ observed SSI-prevention practice and in-hospital SSI occurrence after a structured bundle intervention.

Methods: A pre-post interventional study was conducted from November 2025 to April 2026 in General Surgery and Orthopaedic Surgery wards of a tertiary hospital in Kolkata. Seventy-six nurses were observed before and after intervention using a 10-item checklist. Patient surveillance included 386 patients before and 470 after intervention. The bundle combined teaching, demonstration, bedside reinforcement, observation and feedback. Practice scores were compared using the Wilcoxon signed-rank test and SSI proportions using Pearson’s chi-square test. Risk estimates and multivariable logistic regression were calculated.

Results: Mean practice score increased from 5.21±1.36 to 6.78±2.96; median score increased from 5 to 8, and good practice from 2.6% to 53.9% (Z=-4.01, p<0.001; r=0.46). SSI decreased from 20.21% (78/386) to 14.89% (70/470) (χ²=4.185, p=0.041). RR was 0.74 (95% CI 0.55-0.99) and ARR 5.32 percentage points (95% CI 0.17-10.45). Adjusted odds were lower after intervention (AOR=0.70, 95% CI 0.489-0.999; p=0.0495).

Conclusions: The bundle was followed by better observed nursing practice and lower in-hospital SSI occurrence. The adjusted result was close to the 0.05 threshold; the absence of a concurrent control group and post-discharge surveillance limits causal interpretation.

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