Implementation of a Plan–Do–Study–Act framework to reduce unindicated surgical antimicrobial prophylaxis

Kashtan, Mark A.; Dawson, Michele; Anandalwar, Seema P.; Hills–Dunlap, Jonathan L.; Rangel, Shawn J.

doi:10.1016/j.jpedsurg.2019.09.059

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…There are several possible explanations for the observed magnitude of noncompliance in this analysis and others. Factors including physician training environment,17 lack of knowledge surrounding contemporary guidelines and true SSI risk, and medical reimbursement structures may contribute to physician prescribing practices surrounding antibiotic prophylaxis 18,19. Pressure from regulatory agencies may tend to emphasize SSI reduction over antibiotic stewardship, which has been shown to influence provider practice patterns 18.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated wide practice variation and poor compliance around the use of antimicrobial prophylaxis in pediatric surgery. However, these studies have largely focused on individual dimensions of utilization (eg, indication, spectrum, or duration compliance separately), or have been limited to single-center experiences or individual procedures 4,9–18. A more comprehensive assessment of guideline compliance within pediatric surgery across all dimensions of utilization is needed to provide further insight into which procedures are in greatest need of antimicrobial stewardship efforts.…”

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confidence: 99%

“…However, these studies have largely focused on individual dimensions of utilization (eg, indication, spectrum, or duration compliance separately), or have been limited to singlecenter experiences or individual procedures. 4,[9][10][11][12][13][14][15][16][17][18] A more comprehensive assessment of guideline compliance within pediatric surgery across all dimensions of utilization is needed to provide further insight into which procedures are in greatest need of antimicrobial stewardship efforts. With these considerations, the goal of this study was to characterize and quantify compliance with consensus guidelines across all dimensions of antibiotic prophylaxis utilization to establish a prioritization framework for antimicrobial stewardship efforts in pediatric surgery.…”

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confidence: 99%

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Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery

et al. 2022

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Objective: To quantify procedure-level inappropriate antimicrobial prophylaxis utilization as a strategy to identify high-priority targets for stewardship efforts in pediatric surgery. Background: Little data exist to guide the prioritization of antibiotic stewardship efforts as they relate to prophylaxis utilization in pediatric surgery. Methods: This was a retrospective cohort analysis of children undergoing elective surgical procedures at 52 children’s hospitals from October 2015 to December 2019 using the Pediatric Health Information System database. Procedure-level compliance with consensus guidelines for prophylaxis utilization was assessed for indication, antimicrobial spectrum, and duration. The relative contribution of each procedure to the overall burden of noncompliant cases was calculated to establish a prioritization framework for stewardship efforts. Results: A total of 56,845 cases were included with an overall inappropriate utilization rate of 56%. The most common reason for noncompliance was unindicated utilization (43%), followed by prolonged duration (32%) and use of excessively broad-spectrum agents (25%). Procedures with the greatest relative contribution to noncompliant cases included cholecystectomy and repair of inguinal and umbilical hernias for unindicated utilization (63.2% of all cases); small bowel resections, gastrostomy, and colorectal procedures for use of excessively broad-spectrum agents (70.1%) and pectus excavatum repair and procedures involving the small and large bowel for prolonged duration (57.6%). More than half of all noncompliant cases were associated with 5 procedures (cholecystectomy, small bowel procedures, inguinal hernia repair, gastrostomy, and pectus excavatum). Conclusions: Cholecystectomy, inguinal hernia repair, and procedures involving the small and large bowel should be considered high-priority targets for antimicrobial stewardship efforts in pediatric surgery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery

et al. 2022

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“…Plan‐Do‐Study‐Act frameworks have been implemented to reduce unindicated SAP (Dawson et al, 2020) in human hospitals. A pre‐post‐intervention study of children undergoing clean surgical procedures without foreign body implantation achieved an 85% reduction in unindicated SAP.…”

Section: Impact Of and Barriers To Aspmentioning

confidence: 99%

Surgical antimicrobial prophylaxis: Current standards of care

Southwood

2023

Equine Veterinary Education

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SummaryAntimicrobial drug resistance is a critical problem in human and veterinary medicine. Antimicrobial drug use and particularly overuse or misuse drive resistance. Surgical antimicrobial prophylaxis (SAP) is one area where misuse and overuse (particularly prolonged SAP) is documented to be at a high level. Infection‐related complications can be devastating to the patient, harm the client/patient–surgeon relationship and damage the reputation of the surgeon. Consequently, surgeons tend to be reluctant to change their antimicrobial prescribing behaviour. There is a plethora of data from human surgery and emerging data from veterinary surgery describing appropriate SAP and supporting the use of shorter duration of SAP. Antimicrobial stewardship programs (ASPs) have been developed and evaluated in human hospitals and this type of collaborative approach would likely have benefit in veterinary hospitals.

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“…The result was that there was a 21% reduction in SSIs. A plan/do/study/act cycles method was also used in a 2019 study conducted at the Department of Surgery, Boston Children’s Hospital, to reduce unindicated surgical antimicrobial prophylaxis that was significantly reduced by implementing the intervention bundle [ 138 ]. Another study conducted in Ohio with eight children’s hospitals highlighted how the use of bundles for three preoperative actions (prohibition of razors for skin preparation, chlorhexidine- alcohol use for incisional site preparation and correct timing of prophylactic antibiotic administration) could reduce the incidence of SSIs [ 139 ].…”

Section: Implementation Of Surgical Site Infections Prevention Measuresmentioning

confidence: 99%

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

et al. 2022

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A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.

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Implementation of a Plan–Do–Study–Act framework to reduce unindicated surgical antimicrobial prophylaxis

Cited by 9 publications

References 21 publications

Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery

Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery

Surgical antimicrobial prophylaxis: Current standards of care

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

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