Implementation of a multifaceted program to sustainably improve appropriate intraoperative antibiotic redosing

O'Sullivan, Cormac T; Rogers, William Kirke; Ackman, Mark; Goto, Michihiko; Hoff, Brian M

doi:10.1016/j.ajic.2018.06.007

Cited by 14 publications

(25 citation statements)

References 27 publications

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“…Our study has a limitation: we could not analyse the timing and the possible redosing of SAP. Several studies have confirmed the relationship between the timing of SAP and SSI risk and the importance of maintaining adequate antibiotic serum concentrations throughout the operation [21][22][23][24][25][26][27]. The monitoring of these two important parameters will also be included in our analysis in the near future.…”

Section: Discussionmentioning

confidence: 90%

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Tiri

Bruzzone²,

Priante

et al. 2020

Antibiotics

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Surgical site infections (SSIs) are the most common healthcare-associated infections. The appropriate use of Surgical Antibiotic Prophylaxis (SAP) is a key component to reduce SSIs, while its inappropriate application is a major cause of some emerging infections and selects for antibiotic resistance. We describe an Antimicrobial Stewardship (AMS) intervention on SAP appropriateness. The prospective study was conducted in an Italian hospital, in 12 main surgical units, and was organized in three subsequent phases, as follows. Phase 0: Definition of hospital evidence-based guidelines and a new workflow to optimize the process of ordering, dispensing, administering and documenting the SAP. Phase 1: We analysed 2059 elective surgical cases from January to June 2018 for three SAP parameters of appropriateness: indication, choice and dose. Phase 2: In July 2018, an audit was performed to analyse the results; we reviewed 1781 elective surgical procedures from July to December 2018 looking for the same three SAP appropriateness parameters. The comparative analysis between phases 1 and 2 demonstrated that the correct indication, the correct dose and the overall compliance significantly improved (p-value 0.00128, p-value < 2.2·1016 and p-value < 5.6·1012 respectively). Our prospective study demonstrates a model of successful antimicrobial stewardship intervention that improves appropriateness on SAP.

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Section: Discussionmentioning

confidence: 90%

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Tiri

Bruzzone²,

Priante

et al. 2020

Antibiotics

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show abstract

“…Surgical site infections (SSIs) are infections of the incision or organ space that occur after surgery. 1,2 SSIs are reported in approximately 2%−3% of surgical procedures and are associated with increased morbidity and mortality. [1][2][3] The cost of treating SSIs in the United States is increasing.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 SSIs are reported in approximately 2%−3% of surgical procedures and are associated with increased morbidity and mortality. [1][2][3] The cost of treating SSIs in the United States is increasing. 1 Solutions for Patient Safety (SPS) estimates an average cost of $27,000 per SSI, with a range of $11,778 to $42,177.…”

Section: Introductionmentioning

confidence: 99%

“…1 Annually, the estimated cost to the U.S. health system is between 15.8 and 57.2 billion dollars. 2 It is often difficult to determine the cost of an individual SSI, and this is true at Children's Hospital & Medical Center because direct cost accounting is not used. Approximately 40% to 60% of SSIs are preventable.…”

Section: Introductionmentioning

confidence: 99%

“…7 Correctly administered perioperative prophylactic antibiotics decrease the rate of SSIs. 1,2 Clinical practice guidelines for antimicrobial prophylaxis published in the American Journal of Health-System Pharmacy recommend intraoperative antibiotic dosing intervals during surgical procedures based on the pharmacokinetics of each drug. 2,8 In the cardiac surgical patient population, correct intraoperative antibiotic redosing has decreased SSI rates.…”

Section: Introductionmentioning

confidence: 99%

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Improving the Compliance of Intraoperative Antibiotic Redosing: A Quality Improvement Initiative

LeRiger

Phipps

Norton

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: At Children's Hospital and Medical Center in Omaha, Nebraska, the intraoperative antibiotic redosing guidelines and the time frame considered compliant for redosing were unclear. This lack of clarity plus an ill-defined process for ensuring intraoperative antibiotic redosing resulted in a compliance rate of 11%. The organization's surgical site infection (SSI) rate was 3.19%, above the national benchmark of 1.87%. The primary project goal was to increase intraoperative antibiotic redosing compliance. The secondary project goal was to decrease SSIs. Methods: With recommendations from the Infectious Disease Society of America, we developed new organizational redosing guidelines, as well as a new antibiotic-specific reminder alert in the electronic medical record. Implementation of the new guidelines and processes occurred after providing education to the anesthesiologists, surgeons, and circulating nurses. Monthly evaluation of data allowed for quick recognition of oversights followed by the initiation of process updates. Results: Data showed that the initial compliance rate for the intraoperative redosing of antibiotics was 11%. Following interventions, compliance has reached and sustained an average of 99%. Survey results show that provider knowledge of the guidelines and process has improved. Though not directly related, the National Surgical Quality Improvement Program observed that the SSI rate decreased from 3.19% in 2014 to 2.3% in 2018. Conclusions: This project demonstrates that comprehensive education along with antibiotic-specific electronic medical record alerts significantly increased the compliance of intraoperative antibiotic redosing at Children's Hospital & Medical Center. Continuous education and monthly updates sustained results for over 40 months.

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Adherence to Guidelines for the Administration of Intraoperative Antibiotics in a Nationwide US Sample

Bardia

Michel

Dai³

et al. 2021

JAMA Netw Open

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IMPORTANCEDespite widespread adherence to Surgical Care Improvement Project antibiotic measures, prevention of surgical site infections (SSIs) remains a clinical challenge. Several components of perioperative antibiotic prophylaxis guidelines are incompletely monitored and reported within the Surgical Care Improvement Project program. OBJECTIVES To describe adherence to each component of perioperative antibiotic prophylaxis guidelines in regard to procedure-specific antibiotic choice, weight-adjusted dosing, and timing of first and subsequent administrations in a nationwide, multicenter cohort of patients undergoing noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients undergoing general, urological, orthopedic, and gynecological surgical procedures involving skin incision between January 1, 2014, and December 31, 2018, across 31 academic and community hospitals identified within the Multicenter Perioperative Outcomes Group registry. Data were analyzed between April 2 and April 21, 2021. MAIN OUTCOMES AND MEASURES The primary end point was overall adherence to InfectiousDiseases Society of America guidelines, including (1) appropriateness of antibiotic choice, (2) weightbased dose adjustment, (3) timing of administration with respect to surgical incision, and (4) timing of redosing when indicated. Data were analyzed using mixed-effects regression to investigate patient, clinician, and institutional factors associated with guideline adherence. RESULTSIn the final cohort of 414 851 encounters across 31 institutions, 51.8% of patients were women, the mean (SD) age was 57.5 (15.7) years, 1.2% of patients were of Hispanic ethnicity, and 10.2% were Black. In this cohort, 148 804 encounters (35.9%) did not adhere to guidelines: 19.7% for antibiotic choice, 17.1% for weight-adjusted dosing, 0.6% for timing of first dose, and 26.8% for redosing. In adjusted analyses, overall nonadherence was associated with emergency surgery (odds

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Implementation of a multifaceted program to sustainably improve appropriate intraoperative antibiotic redosing

Cited by 14 publications

References 27 publications

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

Improving the Compliance of Intraoperative Antibiotic Redosing: A Quality Improvement Initiative

Adherence to Guidelines for the Administration of Intraoperative Antibiotics in a Nationwide US Sample

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