Effectiveness of a nursing-led perioperative bundle to prevent surgical site infection through timely administration of prophylactic antibiotics, glucose and temperature control, and avoidance of preoperative shaving
DOI:
https://doi.org/10.70577/asce.v5i2.941Keywords:
surgical site infection, perioperative bundle, antibiotic prophylaxis, glycemic control, normothermiaAbstract
The effectiveness of a nurse-led perioperative bundle for preventing surgical site infection was evaluated through timely antibiotic prophylaxis, glucose and temperature control, and avoidance of preoperative shaving. A systematic review was conducted according to PRISMA 2020 guidelines, searching PubMed, MEDLINE, Embase, CINAHL, Scopus, Web of Science, Cochrane Library, and LILACS, in addition to manual review. Twenty studies published between 2021 and 2025, with surgical site infection as the primary outcome (usually at 30 days), were included. Quasi-experimental and quality-improvement designs predominated, with two pragmatic trials. The synthesis showed relevant reductions in surgical site infection when process gaps existed and high adherence to the bundle was achieved, with reductions reported in colon surgery, emergency appendectomy, and cardiac surgery. In settings with high baseline standards, one trial did not demonstrate incremental benefit. Full compliance was associated with lower infection rates compared to partial compliance, highlighting the role of checklists, auditing, and shift feedback. In conclusion, the bundle is most effective when implemented with high fidelity, coordination, and sustained nursing leadership.
Downloads
References
Abdulsalam Aleid, Aldanyowi, S. N., Aljabr, A., Alaidarous, H. A. A., Aleid, Z., Alharthi, A., Alsubaie, M., AlOraini, L., Almoslem, A., & Al Mutair, A. (2024). Effect of preoperative hair removal vs. no removal on surgical site infections: A systematic review and meta-analysis. F1000Research, 13, 1487. doi:10.12688/f1000research.158369.1
Association of periOperative Registered Nurses. (2024, September 16). Infection prevention for perioperative nurses: A vital role in patient safety. (Periop Life Blog). Recuperado el 5 de marzo de 2026, del sitio web de AORN.
Busada, B. J. (2024). Evaluating and improving surgical site infection prevention: Outcomes of a two-cycle audit and targeted interventions in a low-resource setting. Cureus, 16(12), e75962. doi:10.7759/cureus.75962
Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., et al. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ, 368, l6890. doi:10.1136/bmj.l6890
Centers for Disease Control and Prevention. (2026). 2024 National and state healthcare-associated infections progress report. Recuperado el 5 de marzo de 2026, del sitio web de CDC.
Centers for Disease Control and Prevention. (2026). Surgical site infection (SSI) event. En National Healthcare Safety Network (NHSN) patient safety component manual: Procedure-associated module (enero 2026).
Centre for Health Protection. (2025). Recommendations on prevention of surgical site infection (3.ª ed.). Department of Health, The Government of the Hong Kong Special Administrative Region.
Chaker, S. C., James, A. J., Perdikis, G., & Nthumba, P. (2024). Surgical care bundles for surgical site infection prevention in high-income and low-to-middle-income countries: A comparative review. Perioperative Care and Operating Room Management, 35, 100406. doi:10.1016/j.pcorm.2024.100406
Chen, R., Du, Y., Chen, L., et al. (2025). The impact of perioperative hypothermia on surgical site infection risk: A meta-analysis. BMC Anesthesiology, 25(1). doi:10.1186/s12871-025-03277-7
Chien, Y.-S., Chen, H.-T., Chiang, H.-T., Luo, T.-S., Yeh, H.-I., Sheu, J.-C., & Li, J.-Y. (2024). Effect of standardized bundle care and bundle compliance on reducing surgical site infections: A pragmatic retrospective cohort study. Medical Science Monitor, 30, e943493. doi:10.12659/MSM.943493
Ching, P. R. (2024). Care bundles in surgical site infection prevention: A narrative review. Current Infectious Disease Reports, 26(6), 163–172. doi:10.1007/s11908-024-00837-9
Cochrane. (2024). Cochrane handbook for systematic reviews of interventions (Version 6.5). Cochrane.
Conoscenti, E., Enea, G., Deschepper, M., Huis in ’t Veld, D., Campanella, M., Raffa, G., et al. (2025). A quality improvement program to reduce surgical site infections after cardiac surgery: A 10-year cohort study. Intensive and Critical Care Nursing, 87, 103926. doi:10.1016/j.iccn.2024.103926
Deslarzes, P., Jurt, J., et al. (2023). Prospective compliance assessment of surgical site infection prevention measures in colorectal surgery. BJS Open, 7(2), zrad013. doi:10.1093/bjsopen/zrad013
Garnier, M., et al. (2026). Guidelines on antibiotic prophylaxis in surgery 2024. Anaesthesia Critical Care & Pain Medicine, 101749. doi:10.1016/j.accpm.2026.101749
Guerrero, M. A., Anderson, B., Carr, G., Snyder, K. L., Boyle, P., Ugwu, S. A., Davis, M., Bohnenkamp, S. K., Nfonsam, V., & Riall, T. S. (2021). Adherence to a standardized infection reduction bundle decreases surgical site infections after colon surgery: A retrospective cohort study on 526 patients. Patient Safety in Surgery, 15(1), 15. doi:10.1186/s13037-021-00285-7
Isand, K.-G., et al. (2025). A care bundle to prevent surgical site infections in emergency general surgery: A prospective cohort study. World Journal of Surgery. doi:10.1002/wjs.12657
Jerónimo, L., & Afonso, A. (2025). Interventions by perioperative nurses in the prevention of surgical site infections: Scoping review. Millenium – Journal of Education, Technologies, and Health, 2(28), e42071. doi:10.29352/mill0228.42071
Joanna Briggs Institute. (2024). Critical appraisal tools. Recuperado el 5 de marzo de 2026, del sitio web de JBI.
Jurt, J., Hübner, M., Clerc, D., Curchod, P., Abd El Aziz, M. A., Hahnloser, D., Senn, L., Demartines, N., & Grass, F. (2021). Challenges related to surgical site infection prevention—Results after standardized bundle implementation. Journal of Clinical Medicine, 10(19), 4524. doi:10.3390/jcm10194524
Jurt, J., et al. (2022). Implementing a surgical site infection prevention bundle for emergency appendectomy: Worth the effort or waste of time? Surgery, 172(1), 11–15. doi:10.1016/j.surg.2022.01.027
Lai, J., Li, Q., He, Y., et al. (2022). Glycemic control regimens in the prevention of surgical site infections: A meta-analysis of randomized clinical trials. Frontiers in Surgery, 9, 855409. doi:10.3389/fsurg.2022.855409
Lakkanna, A., Rajender, G., Sakaray, Y. R., Tandup, C., Khare, S., Savlania, A., Kajal, K., Varma, P., Gupta, A., & Kaman, L. (2025). Impact of the timing of antibiotic prophylaxis on the surgical site infections in patients undergoing elective general surgery. Indian Journal of Pharmacology, 57(5), 334–337. doi:10.4103/ijp.ijp_797_24
Lohsiriwat, V. (2021). High compliance with surgical site infection (SSI) prevention bundle reduces incisional SSI after colorectal surgery. Annals of Coloproctology, 37(3), 146–152. doi:10.3393/ac.2020.04.10.2
Martínez-Nicolás, I., Arnal-Velasco, D., Romero-García, E., et al. (2024). Perioperative patient safety recommendations: Systematic review of clinical practice guidelines. BJS Open, 8(6), zrae143. doi:10.1093/bjsopen/zrae143
Moran, M., Zimbric, M. L., Schmitz, M., Safdar, N., & Pop-Vicas, A. (2025). The implementation of complex infection control bundles to prevent colorectal surgical site infections: A survey of SHEA research network hospitals. Antimicrobial Stewardship & Healthcare Epidemiology, 5(1). doi:10.1017/ash.2025.183
Morris, A. J., et al. (2025). Timing of antibacterial prophylaxis and surgical site infection rates in clean orthopaedic and cardiac surgery. BJS Open, 9(6), zraf120. doi:10.1093/bjsopen/zraf120
Nikolic, V., et al. (2025). Empowering patients through a perioperative prevention bundle to reduce surgical site infections in colorectal surgery. American Journal of Infection Control, 53(7), 753–759. doi:10.1016/j.ajic.2025.03.151
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. doi:10.1136/bmj.n71
Qaddumi, J., et al. (2025). Effect of surgical site infection bundles in cardiac surgery: Incidence, microbiology, and risk factors. [Revista no visible en el extracto consultado]. PMID: 41143448.
Rezaei, A. R., et al. (2025). Surgical site infections: A comprehensive review. [Revista no visible en el extracto consultado]. PMID: 40571954.
Rosa, R., Sposato, K., & Abbo, L. M. (2023). Preventing surgical site infections: Implementing strategies throughout the perioperative continuum. AORN Journal, 117(5), 300–311. doi:10.1002/aorn.13913
Seidelman, J. L., Mantyh, C. R., & Anderson, D. J. (2023). Surgical site infection prevention: A review. JAMA, 329(3), 244–252. doi:10.1001/jama.2022.24075
Shi, Z.-Y., et al. (2022). Sustaining improvements of surgical site infections by Six Sigma DMAIC approach. Healthcare, 10(11), 2291. doi:10.3390/healthcare10112291
Suzuki, H., et al. (2023). Implementation of a prevention bundle to decrease rates of Staphylococcus aureus surgical site infection at 11 Veterans Affairs hospitals. JAMA Network Open, 6(7), e2324516. doi:10.1001/jamanetworkopen.2023.24516
Uçak, A., Tat Çatal, A., Karadağ, E., & Cebeci, F. (2024). The effect of prewarming on perioperative hypothermia: A systematic review and meta-analysis of randomized controlled studies. Journal of Perianesthesia Nursing, 39(4), 611–623.e2. doi:10.1016/j.jopan.2023.11.003
van Dijk, M. D., et al. (2023). Effects of a management team training intervention on the compliance with a surgical site infection bundle: A before-after study in operating theatres in the Netherlands. BMJ Open, 13(4), e073137. doi:10.1136/bmjopen-2023-073137
Wiesler, B., et al. (2024). Effect of a colorectal bundle in an entire healthcare region in Switzerland: Results from a prospective cohort study (EvaCol study). BJS Open. PMID: 39453984.
Wolfhagen, N., Boldingh, Q. J. J., Boermeester, M. A., & de Jonge, S. W. (2022). Perioperative care bundles for the prevention of surgical-site infections: Meta-analysis. British Journal of Surgery, 109(10), 933–942. doi:10.1093/bjs/znac196
Wolfhagen, N., et al. (2025). A care bundle added to standard care versus standard care for the prevention of surgical site infections after abdominal surgery (EPO2CH trial): A randomised, open label, pragmatic, superiority multicentre trial. The Lancet Regional Health – Europe. PMID: 41030844.
Çakir, H., & Yilmaz, M. (2025). Impact of a care bundle on surgical site infections and patient comfort in bariatric surgery: A randomized prospective study. Obesity Surgery. PMID: 40848119.
Flores-Yelamos, M., et al. (2024). Comparison of two bundles for reducing surgical site infection in colorectal surgery: Multicentre cohort study. BJS Open.
Alpat, S., & Asam, M. (2023). The use of protocolised care bundle to prevent paediatric cardiac surgical site infection in resource-limited setting. Cardiology in the Young, 33(8). doi:10.1017/S1047951123001798
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ana Cristina Bautista Sinchico , Karla Nicole Tobar Espinosa , Daniela Anahi Diaz Tamba , Msc. Sandra Lorena López Reyes , Msc. Jacqueline de los Ángeles Realpe Sandoval
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Eres libre de:
- Compartir : copiar y redistribuir el material en cualquier medio o formato
- Adaptar : remezclar, transformar y desarrollar el material
- El licenciante no puede revocar estas libertades siempre y cuando usted cumpla con los términos de la licencia.
En los siguientes términos:
- Atribución : Debe otorgar el crédito correspondiente , proporcionar un enlace a la licencia e indicar si se realizaron cambios . Puede hacerlo de cualquier manera razonable, pero no de ninguna manera que sugiera que el licenciante lo respalda a usted o a su uso.
- No comercial : no puede utilizar el material con fines comerciales .
- CompartirIgual — Si remezcla, transforma o construye sobre el material, debe distribuir sus contribuciones bajo la misma licencia que el original.
- Sin restricciones adicionales : no puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otros hacer algo que la licencia permite.
