Effectiveness of the 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 nationwide programme to prevent surgical site infections (SSIs), sponsored by the Ministry of Health. The programme includes the application of a bundle of five key preventive measures (5PM): peri-operative antibiotic prophylaxis (PAP), skin antisepsis (SA), hair removal (HR), normothermia and normoglycaemia.

Aim: To assess the effectiveness of the 5PM, applied in a set of Spanish public hospitals between 2017 and 2021, under standard conditions of surgical health care in Spain.

Methods: This prospective cohort study of 33,240 patients from the ZSIP Registry (National Database Network) included surveillance of SSI data of selected surgical interventions, compliance data and other risk factors. Compliance with the 5PM bundle was verified through a specific checklist. The intervention and comparison groups were patients who were compliant with the 5PM bundle and patients who were not compliant with the 5PM bundle, respectively. Adjusted odds ratios (OR) and preventive fractions (PF) were calculated using logistic regression.

Findings: The overall SSI rates for patients in the compliant group and non-compliant group were 4.77% and 6.90%, respectively. Overall compliance with the 5PM bundle was 35.9%, and the compliance rates were highest for PAP (87.2%), SA (82.2%) and HR (78.7%). Compliance with the 5PM bundle had a PF of 32% and adjusted OR of 0.68 (95% confidence interval 0.60-0.76).

Conclusion: The ZSIP, implemented between 2017 and 2021 in Spain, had a significant level of effectiveness against SSIs.