Surgical site infections (SSI) result in significant patient morbidity and excess healthcare costs. Colorectal surgeries have the highest SSI risk, as they manipulate the organ with the largest endogenous bioburden. This risk can be mitigated through complex prevention bundles, shown effective at reducing SSI in multiple studies, although little is known about their “real-world” use.

To obtain further insight into the implementation of SSI prevention bundles consisting of guideline-recommended infection control elements in colorectal surgery, we distributed a multiple-choice survey to the hospitals within the Society for Healthcare Epidemiology of America Research Network from November 2022 to December 2023.

A total of 42 (45%) hospitals completed the survey. The bundle elements most used were intravenous pre-operative antibiotic prophylaxis (88%) and skin prep with an alcohol-chlorhexidine solution (86%). Infection control elements of surgical closure such as glove change and separate instrument tray were reported by 67% and 64%, respectively. Combined oral antibiotics with mechanical bowel prep were reported by 52%. Less than 50% of hospitals reported consistent bundle audit and feedback to frontline surgical staff. The most persistent barriers to implementation were a general culture resistant to change (40%) and clinicians’ lack of compliance with the institutional bundle (38%).

Our study found significant variability in the implementation of bundles consisting of multiple infection control elements to prevent SSI in clinical practice. Further research is needed to determine the strategies most effective in optimizing high-fidelity adoption of complex prevention bundles and to study their effect on SSI in colorectal surgery.

To explore older adults’ and caregivers’ knowledge and perceptions of guidelines for appropriate antibiotics use for bacteria in the urine.

Semi-structured qualitative interviews.

Infectious disease clinics, community senior living facilities, memory care clinics, and general public.

Patients 65 years or older diagnosed with a urinary tract infection (UTI) in the past two years, or caregivers of such patients.

We conducted interviews between March and July 2023. We developed an interview guide based on the COM-B (capability, opportunity, motivation-behavior) behavior change framework. We thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques.

Thirty participants (21 patients, 9 caregivers) enrolled. Most participants understood UTI symptoms such as pain during urination and frequent urination. However, communication with multiple clinicians, misinformation, and unclear symptoms that overlapped with other health issues clouded their understanding of asymptomatic bacteriuria (ASB) and UTIs. Some participants worried that clinicians would be dismissive of symptoms if they suggested a diagnosis of ASB without prescribing antibiotics. Many participants felt that the benefits of taking antibiotics for ASB outweighed harms, though some mentioned fears of personal antibiotic resistance if taking unnecessary antibiotics. No participants mentioned the public health impact of potential antibiotic resistance. Most participants trusted information from clinicians over brochures or websites but wanted to review information after clinical conversations.

Clinician-focused interventions to reduce antibiotic use for ASB should also address patient concerns during clinical visits, and provide standardized high-quality educational materials at the end of the visit.