EFFECTIVENESS OF ZERO SURGICAL INFECTION PROJECT (ZSIP) IN SPANISH HOSPITALS 2017-2021. A PROSPECTIVE COHORT STUDY.

Background: The Zero Surgical Infection Project (ZSIP) in Spain is a nation-wide program to prevent surgical site infections (SSI), sponsored by the Ministry of Health. The program includes the application of 5 key preventive measures (PM) grouped in a bundle: Perioperative antibiotic prophylaxis (PAP), skin antisepsis (SA), hair removal (HR), normothermia (NT) and normoglycemia (NG).

Aim: To assess the effectiveness of the bundle of 5 ZSIP preventive measures, applied in a set of Spanish public hospitals over the period 2017-2021, under standard conditions of surgical healthcare in Spain.

Methods: This was a prospective cohort study of 33,240 patients from the ZSIP Registry (National Database Network). It includes surveillance of SSI data of selected surgical interventions, compliance data and other risk factors. Compliance with the PM was verified through a specific checklist. The intervention and comparison groups were, those patients compliant and those non-compliant with the 5PM bundle, respectively. We calculated adjusted odds ratio (OR) and preventive fraction (PF) using logistic regression.

Findings: Overall SSI rate for patients in the compliant vs. not compliant 5PM bundle groups were 4.77% vs. 6.90%. Overall compliance of 5 PM bundle was 35.9%, and was higher in PAP (87.2%), SA (82.2%) and HR (78.7%). Compliance of 5PM bundle of ZSIP presents a PF of 32%, adjusted OR 0.68 (IC 95% 0.60-0.76).

Conclusion: The preventive intervention of the ZSIP implemented over the period 2017-21 in Spain achieved a significant level of effectiveness against SSI.