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Sartelli M, Boermeester MA, Cainzos M, Coccolini F, de Jonge SW, Rasa K, Dellinger EP, McNamara DA, Fry DE, Cui Y, Delibegovic S, Demetrashvili Z, De Simone B, Gkiokas G, Hardcastle TC, Itani KMF, Isik A, Labricciosa FM, Lohsiriwat V, Marwah S, Pintar T, Rickard J, Shelat VG, Catena F, Barie PS. Six Long-Standing Questions about Antibiotic Prophylaxis in Surgery. Antibiotics (Basel) 2023; 12:antibiotics12050908. [PMID: 37237811 DOI: 10.3390/antibiotics12050908] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.
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Affiliation(s)
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Miguel Cainzos
- Department of Surgery, Hospital Clínico Universitario, 15706 Santiago de Compostela, Spain
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, 55126 Pisa, Italy
| | - Stijn W de Jonge
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ Amsterdam, The Netherlands
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, 41200 Kocaeli, Turkey
| | | | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, D09V2N0 Dublin, Ireland
| | - Donald E Fry
- Department of Surgery, Northwestern University, Chicago, IL 60208, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi 0162, Georgia
| | - Belinda De Simone
- Department of Emergency and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, 78300 Poissy CEDEX, France
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Timothy C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Mayville 4058, South Africa
| | - Kamal M F Itani
- Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA 02118, USA
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, 34700 Istanbul, Turkey
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak 124001, India
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vishal G Shelat
- Department of Hepato-Pancreatic-Biliary Surgery, Tan Tok Seng Hospital, Singapore 308433, Singapore
| | - Fausto Catena
- Department of Surgery, "Bufalini" Hospital, 47023 Cesena, Italy
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medicine, E. Northport, New York, NY 11731, USA
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Vazin A, Hatami-Mazinani N, Alemzadeh E, Dehghani F, Mahi-Birjand M. Compliance with Antibiotics Prophylaxis Guideline in Surgical Patients in ICUs of a Teaching Referral Hospital. Health Serv Insights 2022; 15:11786329221136437. [PMID: 36386270 PMCID: PMC9661573 DOI: 10.1177/11786329221136437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial prophylaxis used for surgical procedures remains one of the measures for the prevention of surgical site infections (SSIs). The present study was designed to assess the compliance with clinical practice guideline for antimicrobial prophylaxis in variable surgeries conducted in the intensive care units (ICUs) of a major referral hospital. This cross-sectional investigation was carried out by prospective data collected from October 2017 to March 2018 in the intensive care unit (ICU) of Nemazi hospital in Shiraz. Demographic characteristics, surgery type as well as antibiotic treatment were gathered from medical records and entered in data collection forms. We reviewed compliance and adherence of prophylactic antibiotic administration to the Infectious Diseases Society of America (IDSA) guideline and evaluated the courses of antimicrobial drugs. If an antibiotic administrated for surgical prophylaxis was different from the guideline, the antibiotic was classified as non-guideline-based antibiotics. Most patients participated in this study were male (64.5%). Only 8.75% of the administrated antibiotics chosen for surgical prophylaxis were found to be appropriate antibiotic prescriptions; however, those patients receiving appropriate antibiotics prescribed an inappropriate dosage. In addition, the antibiotics were administrated with inappropriate durations in all cases. Our findings indicated that adherence to the IDSA international guideline seems to be far from ideal in Namazi hospital for antimicrobial prophylaxis, resulting in the unsuitable administration of a wide variety of antibiotics.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, School of pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazafarin Hatami-Mazinani
- Department of Clinical Pharmacy, School of pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Effat Alemzadeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Dehghani
- Student Research Committee, Larestan University of Medical Sciences, Laresta, Iran
| | - Motahareh Mahi-Birjand
- Department of Clinical Pharmacy, School of Pharmacy, Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Wæhle HV, Harthug S, Søfteland E, Sevdalis N, Smith I, Wiig S, Aase K, Haugen AS. Investigation of perioperative work processes in provision of antibiotic prophylaxis: a prospective descriptive qualitative study across surgical specialties in Norway. BMJ Open 2019; 9:e029671. [PMID: 31230033 PMCID: PMC6596935 DOI: 10.1136/bmjopen-2019-029671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Surgical site infections are known postoperative complications, yet the most preventable of healthcare-associated infections. Correct provision of surgical antibiotic prophylaxis (SAP) is crucial. Use of the WHO Safe Surgical Checklist (SSC) has been reported to improve provision of SAP, and reduce infections postoperatively. To understand possible mechanisms and interactions generating such effects, we explored the underlying work processes of SAP provision and SSC performance at the intersection of perioperative procedures and actual team working. DESIGN An ethnographic study including observations and in-depth interviews. A combination of deductive and inductive content analysis of the data was conducted. SETTING Operating theatres with different surgical specialities, in three Norwegian hospitals. PARTICIPANTS Observations of perioperative team working (40 hours) and in-depth interviews of 19 experienced perioperative team members were conducted. Interview participants followed a maximum variation purposive sampling strategy. RESULTS Analysis identified provision of SAP as a process of linked activities; sequenced, yet disconnected in time and space throughout the perioperative phase. Provision of SAP was handled in relation to several interactive factors: preparation and administration, prescription accuracy, diversity of prescription order systems, patient-specific conditions and changes in operating theatre schedules. However, prescription checks were performed either as formal SSC reviews of SAP items or as informal checks of relevant documents. In addition, use of cognitive reminders and clinical experiences were identified as mechanisms used to enable administration of SAP within the 60 min timeframe described in the SSC. CONCLUSION Provision of SAP was identified as a complex process. Yet, a key element in provision of SAP was the given 60 min. timeframe of administration before incision, provided in the SSC. Thus, the SSC seems beneficial in supporting timely SAP administration practice by either being a cognitive tool and/or as a cognitive intervention.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College, London, UK
| | - Ingrid Smith
- Department of Essential Medicines and Health Products, World Health Organization, Geneve, Switzerland
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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Harbi H, Merzougui L, Barhoumi MH, Rebai H, Abdelkefi S, El Kamel R, Barhoumi T. [Evaluation of surgical antibiotic prophylaxis in a Tunisian University Hospital]. Pan Afr Med J 2018; 30:191. [PMID: 30455820 PMCID: PMC6235464 DOI: 10.11604/pamj.2018.30.191.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022] Open
Abstract
Antibiotic prophylaxis (ATBP) is one of the specific measures for the prevention of surgical site infections, whose impact has been quantified in clean or clean-contaminated surgery. Our study aims to evaluate the conformity of ATBP practices and the adherence to the prescribing protocols adopted in our Hospital. We conducted a clinical audit retrospective observational study, evaluating antibiotic prophylaxis practices in our Hospital in the month of March 2015. The primary study endpoint was the overall compliance of the observed practices with the 5 major criteria defined by the French National Authority for Health (FNAH). We followed the guidelines of the French Society of Anesthesia and Intensive Care published in 2010. The study included 150 patients who had undergone surgery in the Department of General Surgery, Orthopaedics and Urology. The overall compliance rate was 33.3%. The compliance with each of the 5 major criteria defined by the FNAH was 74% for the indication; 84% for the time between injection and incision; 60% for the choice of ATB; 89.3% for the dose of the first injection and 72% for the duration of ATBP. The compliance was variable depending on the Department; better compliance was reported in the Department of Urology, in scheduled surgery and when the prescriber was an anesthetist-resuscitator. A global strategy including organization, education and restriction, could lead to a real improvement in the rate of compliance with ATBP practices. Successive audits should be carried out regularly in order to evaluate the impact of the undertaken actions.
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Affiliation(s)
- Hayett Harbi
- Direction Régionale de la Santé, Kairouan, Tunisie
| | - Latifa Merzougui
- Service d'Hygiène Hospitalière CHU Ibn El Jazzar, Kairouan, Tunisie
| | | | - Hedi Rebai
- Service d'Orthopédie CHU Ibn El Jazzar, Kairouan, Tunisie
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Antibiotic prophylaxis with cefazolin in reducing the infection rate of non-melanocytic skin tumors: a randomized clinical trial. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1240-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Turnbull BRR, Zoutman DE, Lam M. Evaluation of Hospital and Patient Factors that Influence the effective Administration of Surgical Antimicrobial Prophylaxis. Infect Control Hosp Epidemiol 2016; 26:478-85. [PMID: 15954487 DOI: 10.1086/502571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis.Design:Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug).Setting:A 450-bed, tertiary-care teaching hospital in Canada.Patients:A total of 4,835 patients admitted for surgical procedures who required antimicrobial prophylaxis.Results:Factors positive for an effective first prophylactic dose for all cases were when an order was written (OR, 19.7; CI95, 9.1–42.7; P < .001) and given in the operating room (OR, 13.9; Cl95, 7.5–25.6; P < .001). Factors negative for an effective first prophylactic dose were beta-lactam allergy (OR, 0.49; CI95, 0.4–0.61; P < .001) and same-day surgery (OR, 0.57; CI95, 0.4–0.82; P < .001).Conclusions:With few exceptions, the four factors included in the procedure models showed that when a preoperative order was written or the antibiotic was given in the operating room, a patient was more likely to receive an effective first prophylactic dose. Conversely, when a patient had a beta-lactam allergy or the surgery was performed on the day the patient was admitted, the administration of an effective first prophylactic dose was less likely.
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Affiliation(s)
- Bruce R R Turnbull
- Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada.
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Askarian M, Moravveji AR, Mirkhani H, Namazi S, Weed H. Adherence to American Society of Health-System Pharmacists Surgical Antibiotic Prophylaxis Guidelines in Iran. Infect Control Hosp Epidemiol 2016; 27:876-8. [PMID: 16874651 DOI: 10.1086/506405] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 04/08/2005] [Indexed: 11/03/2022]
Abstract
We assessed the appropriateness of surgical antibiotic prophylaxis in 6 teaching hospitals in Shiraz, Iran, using the American Society of Health-System Pharmacists guideline as a reference. We reviewed the medical records of 1,000 patients who underwent 1 of 9 different surgical procedures (1 procedure per patient). The proportion of procedures in which there was compliance with all guideline recommendations was 0.3%. The most common mistakes were overuse and misuse of antibiotics.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Hosoglu S, Sunbul M, Erol S, Altindis M, Caylan R, Demirdag K, Ucmak H, Mendes H, Geyik MF, Turgut H, Gundes S, Doyuk EK, Aldemir M, Dokucu AI. A National Survey of Surgical Antibiotic Prophylaxis in Turkey. Infect Control Hosp Epidemiol 2015; 24:758-61. [PMID: 14587938 DOI: 10.1086/502127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AbstractObjective:To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures.Design:A cross-sectional, country-wide survey.Setting:Thirty-six hospitals in 12 cities in Turkey.Participants:Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest.Methods:A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures.Results:Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426–3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890–8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225–0.772; P < .001) were associated with inappropriate prophylaxis.Conclusion:Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.
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Bedouch P, Labarère J, Chirpaz E, Allenet B, Lepape A, Fourny M, Pavese P, Girardet P, Merloz P, Saragaglia D, Calop J, Francois P. Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital. Infect Control Hosp Epidemiol 2015; 25:302-7. [PMID: 15108727 DOI: 10.1086/502396] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.Design:Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.Setting:Orthopedic surgery wards in a 2,200-bed French teaching hospital.Patients:A random sample of 416 patients undergoing THR from January 1999 to December 2000.Results:Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).Conclusion:The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.
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Affiliation(s)
- Pierrick Bedouch
- Unité d'Evaluation Médicale, Centre Hospitalier Universitaire de Grenoble, France
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Montes CV, Vilar-Compte D, Velazquez C, Golzarri MF, Cornejo-Juarez P, Larson EL. Risk Factors for Extended Spectrum β-Lactamase-Producing Escherichia coli versus Susceptible E. coli in Surgical Site Infections among Cancer Patients in Mexico. Surg Infect (Larchmt) 2014; 15:627-34. [DOI: 10.1089/sur.2013.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Diana Vilar-Compte
- Instituto Nacional de Cancerología, México City, Distrito Federal, Mexico
| | - Consuelo Velazquez
- Instituto Nacional de Cancerología, México City, Distrito Federal, Mexico
| | | | | | - Elaine L. Larson
- Columbia Mailman School of Public Health, New York, New York
- School of Nursing, Columbia University, New York, New York
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Rafati M, Shiva A, Ahmadi A, Habibi O. Adherence to American society of health-system pharmacists surgical antibiotic prophylaxis guidelines in a teaching hospital. J Res Pharm Pract 2014; 3:62-6. [PMID: 25114939 PMCID: PMC4124682 DOI: 10.4103/2279-042x.137075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: Surgical site infections are the second most common type of adverse events occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital. Methods: This study was conducted at the general surgery and orthopedic wards of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The medical records of admitted patients who underwent different surgical procedures were reviewed. Compliance was assessed with the recommendations of the American Society of Health-System Pharmacists' guidelines for every aspect of antibiotic prophylaxis. All data were coded and analyzed by SPSS16 software using Student's t-test and Chi-square test. Findings: During 1 year, 759 patients who underwent different surgeries were included in the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were in accordance with the American Society of Health System Pharmacists (ASHP) guidelines regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose was lower and in one procedure, it was higher than recommended doses. Conclusion: Although such guidelines have been in place for many years, studies showed that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines are still major issues. It is essential for surgeons to be aware to consider the best antibiotic choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.
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Affiliation(s)
- Mohammadreza Rafati
- Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Afshin Shiva
- Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhosein Ahmadi
- Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Omran Habibi
- Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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12
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Patient Safety: A Perspective from the Developing World. Patient Saf Surg 2014. [DOI: 10.1007/978-1-4471-4369-7_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Barie PS. Guidelines for Antimicrobial Prophylaxis in Surgery: A Must-Read, Must-Heed for Every Surgeon. Surg Infect (Larchmt) 2013; 14:5-7. [DOI: 10.1089/sur.2013.9995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Garcia N, Fogel S, Baker C, Remine S, Jones J. Should Compliance with the Surgical Care Improvement Project (SCIP) Process Measures Determine Medicare and Medicaid Reimbursement Rates? Am Surg 2012. [DOI: 10.1177/000313481207800617] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Surgical Care Improvement Project (SCIP) is aproject that focuses on improving surgical care by reducing surgical morbidity and mortality by 25 per cent by 2010. Starting in 2011, SCIP compliance affects Medicare and Medicaid reimbursement rates. Although SCIP reinforces better practices in surgical care, does compliance with SCIP measures actually result in a decrease in surgical morbidity and mortality? This study examined compliance with the SCIP surgical site infection (SSI) module (prophylactic antibiotic received within 1 hour before surgical incision) during 2009 to 2010 (n = 703) to determine whether patients compliant with SCIP data had a correlation with SSI rates as reported by National Surgery Quality Improvement Program (NSQIP) data for the same time period. We found no statistically significant association in patients that have failed SCIP INF1 in the years 2009 to 2010 (n = 43) and the rates of SSI (n = 0) for the same time period. These data suggest that SCIP compliance should not be used to determine Medicare and Medicaid reimbursement rates because there is no correlation between failure of SCIP INF1 and SSI. Instead, further effort should be placed on developing tools designed to acknowledge outcome measures that result in decreased morbidity/mortality and change practices accordingly such as NSQIP.
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Affiliation(s)
- Nicole Garcia
- Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia
| | - Sandy Fogel
- Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia
| | | | - Stephen Remine
- Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia
| | - Jim Jones
- Carilion Clinic, Roanoke Memorial Hospital, Roanoke, Virginia
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Knights CB, Mateus A, Baines SJ. Current British veterinary attitudes to the use of perioperative antimicrobials in small animal surgery. Vet Rec 2012; 170:646. [PMID: 22562102 DOI: 10.1136/vr.100292] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A questionnaire was sent to 2951 mixed and small animal veterinary practices to examine the use of perioperative antimicrobials in cats and dogs in the UK. The percentage of respondents who always used antimicrobials in two surgical procedures classified according to NRC criteria as 'clean' was 25.3 per cent for removal of a 1 cm cutaneous mass and 32.1 per cent for routine prescrotal castration. Factors considered important in decision-making about when to use antimicrobial agents included immunosuppression, presence of a drain, degree of wound contamination, potential for spillage of visceral contents and implantation of prosthesis. The most common antimicrobial agents mentioned were potentiated amoxicillin (98.0 per cent), amoxicillin (60.5 per cent), clindamycin (21.8 per cent), enrofloxacin (21.7 per cent), cephalexin (18.6 per cent) and metronidazole (12.7 per cent). Forty-three per cent of all responding veterinarians listed a long-acting preparation for perioperative use. The routes used were subcutaneous (76.1 per cent), intravenous (25.8 per cent), intramuscular (19.8 per cent), oral (13.5 per cent) and topical (7.7 per cent). Antimicrobials were given before surgery (66.6 per cent), during surgery (30.2 per cent), immediately after surgery (12.0 per cent) and after surgery (6.3 per cent). This survey has identified the suboptimal use of perioperative antimicrobials in small animal surgery with improvements needed with respect to timing, duration, choice of antimicrobial and a more prudent selection of surgical cases requiring prophylaxis.
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Affiliation(s)
- C B Knights
- Wolfson Centre for Age Related Disease, Room 1.24 Hodgkin Building, Guys Campus, Kings College London, St Thomas St, London, SE1 1UL, UK.
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Hohmann C, Eickhoff C, Radziwill R, Schulz M. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns. Infection 2011; 40:131-7. [PMID: 22002734 DOI: 10.1007/s15010-011-0204-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 09/27/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Surgical site infections (SSIs) are associated with a high morbidity, mortality and healthcare costs. The prevention of SSIs is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis (PAP) and postoperative wound care. Despite an abundance of evidence demonstrating the effectiveness of antimicrobials to prevent SSIs, the use of antimicrobial prophylaxis in this clinical setting is associated with inappropriate timing and selection and excessive duration of administration. To date, pharmacy interns (PIs) have not been involved in this process. The aim of this study was to evaluate feasibility of involving PIs in monitoring adherence to the guidelines for antibiotic prophylaxis in surgery patients. METHODS The study was conducted in seven hospitals in Germany within the framework of the project "Pharmacy interns on the ward" (P-STAT2). Twenty-seven PIs participated, either from either May to October 2008 or from November 2008 to April 2009. Each patient admitted to the participating wards was consecutively monitored. PIs documented the antibiotic prophylaxis and checked the adherence with the hospital ward's PAP guidelines taking both the choice of antibiotic drug and the duration of PAP into account. The costs of antibiotics, personnel and material were calculated in cases of non-adherence with guidelines. RESULTS This is the first time that PIs were involved in monitoring antibiotic prophylaxis guidelines. A total of 6,167 patients were enrolled (mean age 58.3 ± 19.6 years; 47.1% male); of these, 5,064 patients underwent surgery and were ultimately available for evaluation. Guidelines for antibiotic prophylaxis were followed in 70.7% of the cases. CONCLUSIONS The study revealed that many patients do not receive the appropriate antibiotic prophylaxis despite the fact that guidelines are in place. Based on these results, we conclude that PIs may play an important role in antibiotic prophylaxis management.
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Affiliation(s)
- C Hohmann
- Department of Medicine, Federal Union of German Associations of Pharmacists, Jaegerstraße 49-50, Berlin, Germany.
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18
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Preventing surgical-site infections after colorectal surgery. J Infect Chemother 2011; 18:83-9. [PMID: 21904886 DOI: 10.1007/s10156-011-0298-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
Abstract
Surgical-site infection (SSI) is a major contributor to patient mortality rates and health care costs. Due to the high risk of bacterial contamination, colorectal surgery is associated with a particularly high risk of postoperative infection. The surveillance reported here was conducted at Aichi Medical University Hospital on 304 patients who underwent elective colorectal resection--total or partial--from June 2006 to May 2009. To determine risk factors for SSI, multivariate analysis was used. Forty-six (15.1%) patients were diagnosed with SSI. Patients who received cefotiam for prophylaxis showed the highest incidence of SSI (26.6%), and patients who were administered flomoxef showed the lowest incidence (8.1%). Patients who developed SSI were more likely to intraoperative blood loss (308.1 ± 29.8 vs. 153.9 ± 12.2; p < 0.05), longer postoperative antimicrobial administration (5.3 ± 2.2 vs. 4.5 ± 1.5; p < 0.05), and longer operative time (3.3 ± 1.6 vs. 2.7 ± 1.2; p < 0.05). Intraoperative bleeding, antimicrobial choices to cover both anaerobic and aerobic bacteria, and length of antimicrobial administration were independently predictive of SSI development according to multivariate logistic regression analysis. These results suggest that the degree of operative invasion and anaerobic bacteria contribute to SSI following colorectal surgery.
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Ho VP, Barie PS, Stein SL, Trencheva K, Milsom JW, Lee SW, Sonoda T. Antibiotic Regimen and the Timing of Prophylaxis Are Important for Reducing Surgical Site Infection after Elective Abdominal Colorectal Surgery. Surg Infect (Larchmt) 2011; 12:255-60. [DOI: 10.1089/sur.2010.073] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vanessa P. Ho
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Philip S. Barie
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
- Department of Public Health, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sharon L. Stein
- Department of Surgery, University Hospital Case Western Medical Center, Cleveland, Ohio
| | - Koiana Trencheva
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Jeffrey W. Milsom
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sang W. Lee
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Toyooki Sonoda
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Meeks DW, Lally KP, Carrick MM, Lew DF, Thomas EJ, Doyle PD, Kao LS. Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3? Am J Surg 2011; 201:76-83. [DOI: 10.1016/j.amjsurg.2009.07.050] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 05/28/2009] [Accepted: 07/09/2009] [Indexed: 11/28/2022]
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Treitl M, Rademacher A, Becker-Lienau J, Reiser MF, Hoffmann U, Czihal M. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term. Cardiovasc Intervent Radiol 2010; 34:642-6. [DOI: 10.1007/s00270-010-0040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 10/28/2010] [Indexed: 11/28/2022]
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Nemeth TA, Beilman GJ, Hamlin CL, Chipman JG. Preoperative verification of timely antimicrobial prophylaxis does not improve compliance with guidelines. Surg Infect (Larchmt) 2010; 11:387-91. [PMID: 20662740 DOI: 10.1089/sur.2008.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical site infections are reduced by appropriate and timely antimicrobial prophylaxis. Consensus guidelines recommend that antimicrobial infusion begin within 60 min prior to creation of the incision. An internal audit of our institution suggested poor guideline compliance. We hypothesized that the addition of a oral antibiotic verification to the routine preoperative patient identification, operation, and surgical site verification would increase compliance. To this end, we compared compliance with the guidelines before and after the addition of a verification of antibiotic administration to the routine preoperative protocol. METHODS We performed a retrospective medical record review of operations during two five-day periods, one prior to and one after the addition of the antibiotic verification. We identified operative procedure, time of antibiotic administration, time of incision, and the patient's preoperative inpatient or outpatient status. We excluded from analysis patients whose procedure did not require antibiotic prophylaxis, inpatients, and patients without complete records. Administration of antimicrobial prophylaxis was considered timely (< or = 60 min prior to incision), early (> 60 min prior to incision), late (beginning after incision), or not given (no antibiotic administered). Comparisons were made using the chi(2) statistic for noncontinuous variables with significance defined as p < or = 0.05. RESULTS A total of 715 cases were reviewed. Excluded were 315 cases that did not require antibiotic prophylaxis, 88 inpatient procedures, and 22 cases with incomplete records. In the pre-intervention group, 87 of 97 cases (90%) demonstrated timely antibiotic administration. In the post-intervention group, 163 of 193 cases (85%) received timely antibiotic prophylaxis. Although pre-intervention compliance was slightly better than post-intervention, this difference was not significant (p = 0.223). CONCLUSION The addition of verification of timely antimicrobial prophylaxis to the routine preoperative verifications does not improve compliance with the prophylaxis guidelines in the setting of good pre-intervention compliance.
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Affiliation(s)
- Theodora A Nemeth
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
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23
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de Vries EN, Dijkstra L, Smorenburg SM, Meijer RP, Boermeester MA. The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis. Patient Saf Surg 2010; 4:6. [PMID: 20388204 PMCID: PMC2867812 DOI: 10.1186/1754-9493-4-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/13/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration of antibiotic prophylaxis before induction of anaesthesia. The aim of this study was to determine the effect of SURPASS implementation on timing of antibiotic prophylaxis. METHODS A retrospective analysis was performed on two cohorts of patients: one cohort of surgical patients that underwent surgery before implementation of the checklist and a comparable cohort after implementation. The interval between administration of antibiotic prophylaxis and incision was compared between the two cohorts. RESULTS A total of 772 surgical procedures were included. More than half of procedures were gastro-intestinal; others were vascular, trauma and hernia repair procedures. After implementation, the checklist was used in 81.4% of procedures. The interval between administration of antibiotic prophylaxis and incision increased from 23.9 minutes before implementation of SURPASS to 29.9 minutes after implementation (p = 0.047). In procedures where the checklist was used, the interval increased to 32.9 minutes (p = 0.004). The proportion of patients that did not receive antibiotics until after the incision decreased significantly. CONCLUSION The use of the SURPASS checklist leads to better compliance with regard to the timing of antibiotic prophylaxis administration.
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Affiliation(s)
- Eefje N de Vries
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
- Department of Quality and Process Innovation, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lucia Dijkstra
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
- Department of Quality and Process Innovation, Academic Medical Centre, Amsterdam, the Netherlands
| | - Susanne M Smorenburg
- Department of Quality and Process Innovation, Academic Medical Centre, Amsterdam, the Netherlands
| | - R Peter Meijer
- Department of Anaesthesiology, Academic Medical Centre, Amsterdam, the Netherlands
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Pan SC, Kung HC, Lin JW, Hsieh SM, Chang SC. Effectiveness of Workflow Change for Improving the Timing of Prophylactic Antibiotics. Tzu Chi Med J 2009. [DOI: 10.1016/s1016-3190(09)60061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sun TB, Chao SF, Chang BS, Chen TY, Gao PY, Shyr MH. Quality improvements of antimicrobial prophylaxis in coronary artery bypass grafting. J Surg Res 2009; 167:329-35. [PMID: 19922949 DOI: 10.1016/j.jss.2009.06.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 06/15/2009] [Accepted: 06/28/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although the principles of antibiotics prophylaxis are well established, more than 60% of hospitals that joined the international quality indicator project failed to discontinue the use of prophylactic antibiotics within 24h after coronary artery bypass grafting (CABG). Our specific aims are to disseminate the gain obtained from breakthrough series model in knee arthroplasty and abdominal hysterectomy to increase the rate of prophylactic duration not longer than 24h in patients with CABG. METHODS The control and intervention groups enrolled 55 and 78 patients with CABG before and after the project. Measurements were prophylactic interval and duration, surgical site infection, hospital and antibiotics costs. Two strategies were developed. The key cardiac surgeon was invited to attend quality improvement activities. Knowledge and rationale of medical quality indicators would thus be communicated. Secondly, we proposed a regional symposium in which a level of competition was subconsciously established, and practitioners would present their level of compliance. RESULTS Instances of prophylactic interval within 1h prior to incision were significantly increased from 66.7% to 97.4%. Rates of prophylactic duration less than 24h were significantly increased from 2.8% to 66.1%. The average hospital cost was reduced by 16.4%, and antibiotics cost was reduced by 91.8%. No significant changes in surgical site infection within 30 d of CABG were observed. CONCLUSIONS We successfully disseminated the gain of breakthrough project in improving antimicrobial prophylaxis to CABG. By implementing this model, we are able to optimize the timing and duration of antimicrobial prophylaxis in patients with CABG to a level above worldwide average.
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Affiliation(s)
- Tzong-Bor Sun
- Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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Cartmill C, Lingard L, Regehr G, Espin S, Bohnen J, Baker R, Rotstein L. Timing of surgical antibiotic prophylaxis administration: complexities of analysis. BMC Med Res Methodol 2009; 9:43. [PMID: 19549329 PMCID: PMC2711115 DOI: 10.1186/1471-2288-9-43] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 06/23/2009] [Indexed: 11/17/2022] Open
Abstract
Background The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. Challenges Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different timing classifications in a single case. A formalized protocol was developed for dealing with incomplete, ambiguous and unclear documentation. A hierarchical coding system was implemented for managing cases with multiple antibiotic regimens. Interpretation Researchers who are tracking prophylactic antibiotic timing as an outcome measure should be aware that documentation of antibiotic timing in the patient chart is frequently incomplete and unclear, and these inconsistencies should be accounted for in analyses. We have developed a systematic method for dealing with specific problematic patterns encountered in the data. We propose that the general adoption of a systematic approach to analysis of this type of data will allow for cross-study comparisons and ensure that interpretation of results is on the basis of timing practices rather than documentation practices.
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Evaluación del impacto de un programa de vigilancia epidemiológica del consumo de antibióticos y la flora en una clínica de tercer nivel. INFECTIO 2009. [DOI: 10.1016/s0123-9392(09)70138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Preoperative antiseptics in clean/contaminated maxillofacial and oral surgery: prospective randomized study. Int J Oral Maxillofac Surg 2009; 38:160-5. [DOI: 10.1016/j.ijom.2008.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 07/25/2008] [Accepted: 11/24/2008] [Indexed: 11/23/2022]
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Song EK, Yoon TR, Park SJ, Park KS, Jung WB. Protocol for Administration of Prophylactic Antibiotics within One Hour before the Surgical Incision in Total Hip and Knee Replacement. ACTA ACUST UNITED AC 2009. [DOI: 10.4055/jkoa.2009.44.2.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eun Kyoo Song
- Department of Orthopedics, Center for Joint Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Taek Rim Yoon
- Department of Orthopedics, Center for Joint Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Sang Jin Park
- Department of Orthopedics, Center for Joint Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Kyung Sun Park
- Department of Orthopedics, Center for Joint Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea
| | - Woo Bin Jung
- Department of Orthopedics, Center for Joint Diseases, Chonnam National University Hwasun Hospital, Jeonnam, Korea
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Nguyen N, Yegiyants S, Kaloostian C, Abbas MA, Difronzo LA. The Surgical Care Improvement Project (SCIP) Initiative to Reduce Infection in Elective Colorectal Surgery: Which Performance Measures Affect Outcome? Am Surg 2008; 74:1012-6. [DOI: 10.1177/000313480807401028] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One component of the Surgical Care Improvement Project (SCIP) is the prevention of surgical site infections (SSIs) by: 1) timing the administration of prophylactic antibiotics (PAs) within 1 hour of incision; 2) using approved PA regimens; and 3) discontinuing PA within 24 hours. We sought to evaluate institutional compliance with SCIP recommendations in patients undergoing elective colorectal surgery and determine whether they affected the incidence of SSI. One hundred four elective colorectal cases were reviewed. In 58 patients (56%), PAs were administered within 1 hour of incision. In 71 cases (68%), the PA choice was considered compliant. There were a total of 12 SSIs (11.5%) overall. The incidence of SSI was significantly higher in cases in which PAs were not administered within 1 hour of incision (10 of 46 or 22% vs two of 58 or 3.5%, P = 0.005). There was no significant difference in the incidence of SSI in patients who received compliant versus noncompliant PA (12.7% vs 9.1%, P = 0.75). Timely PA administration significantly reduces the incidence of SSI in patients undergoing elective colorectal surgery. Efforts should focus on ensuring that PAs are given in a timely manner to reduce SSI in colorectal surgery.
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Affiliation(s)
- Nhien Nguyen
- From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California
| | - Sara Yegiyants
- From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California
| | - Carolyn Kaloostian
- From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California
| | - Maher A. Abbas
- From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California
| | - L. Andrew Difronzo
- From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California
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Prophylactic Antibiotic Use: Hardwiring of Physician Behavior, Not Education, Leads to Compliance. J Am Coll Surg 2008; 207:88-94. [DOI: 10.1016/j.jamcollsurg.2008.01.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Revised: 01/16/2008] [Accepted: 01/16/2008] [Indexed: 11/23/2022]
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Wu MS, Sun TB, Shyr MH, Wei YC, Chen TY, Chu TY, Ho YH, Wang LS. Quality Improvement of Antimicrobial Prophylaxis for Abdominal Hysterectomy in a Medical Center in Eastern Taiwan. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60020-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Souza HPD, Breigeiron R, Cunha HMD, Deves E. Antibioticoprofilaxia na colecistectomia videolaparoscópica eletiva: estudo prospectivo randomizado e duplo cego. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000300006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Identificar a necessidade de profilaxia antibiótica em colecistectomias videolaparoscópicas eletivas. MÉTODO: Estudo prospectivo, randomizado e duplo-cego, em pacientes submetidos à colecistectomia videolaparoscópica eletiva, durante o período de Junho de 2003 a Julho de 2007, com alocação de 163 pacientes em dois grupos: A (n=82), recebeu profilaxia com cefoxitina 2g intravenoso na indução anestésica; B (n=81), recebeu solução salina 2 mililitros intravenoso. A equipe e a técnica cirúrgica utilizadas foram as mesmas. O desfecho avaliado foram complicações infecciosas de sítio cirúrgico, isto é, infecção de ferida operatória e abscessos superficiais e/ou profundos. Os pacientes foram revisados em sete e 28 dias pós-operatório. Os dados foram analisados pelo Teste exato de Fisher (p<0,05). RESULTADOS: O presente estudo demonstrou uma taxa de complicações infecciosas de 4,76%, no Grupo A e de 6,17% no Grupo B. Não houve diferença estatisticamente significativa (p=0,746) nas taxas de complicações infecciosas. Os grupos foram homogêneos e comparáveis. CONCLUSÃO: Pacientes submetidos à colecistectomia videolaparoscópica eletiva, de baixo risco cirúrgico, não necessitam de antibioticoprofilaxia, pois a mesma não traz redução das taxas de infecção.
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Affiliation(s)
- Hamilton Petry de Souza
- Pontifícia Universidade Católica do Rio Grande do Sul; PUCRS; American College of Surgeons; UNICAMP
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34
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Garey KW, Amrutkar P, Dao-Tran TK, Frost CP, Chen H, Essien EJ, Gentry LO. Economic Benefit of Appropriate Timing of Vancomycin Prophylaxis in Patients Undergoing Cardiovascular Surgery. Pharmacotherapy 2008; 28:699-706. [DOI: 10.1592/phco.28.6.699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rosenberg AD, Wambold D, Kraemer L, Begley-Keyes M, Zuckerman SL, Singh N, Cohen MM, Bennett MV. Ensuring appropriate timing of antimicrobial prophylaxis. J Bone Joint Surg Am 2008; 90:226-32. [PMID: 18245579 DOI: 10.2106/jbjs.g.00297] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Delivery of intravenous antibiotic prophylaxis within one hour prior to surgical incision is considered important in helping to decrease the incidence of surgical site infections, but methods to ensure compliance have not been established. METHODS All patients at our institution are subjected to a surgical "time-out" protocol to prevent wrong-site surgery. During a seven-week period, all patients undergoing spine surgery, total hip arthroplasty, or total knee arthroplasty had another safety initiative, that of ensuring that prophylactic intravenous antibiotics were administered at least one hour prior to incision, "piggybacked" onto our existing time-out verification checklist. In addition, we compared compliance during the study period with compliance during a three-month period prior to institution of this protocol and compliance for eighteen months after institution of this protocol. RESULTS The average time (and standard deviation) between the antibiotic administration and the incision was 26 +/- 12 minutes for all patients. The protocol was effective in ensuring antibiotic administration at the optimal time to 316 (99.1%) of the 319 patients. Analysis of a group of forty patients who had undergone total hip or knee replacement during the three months prior to the beginning of the study demonstrated a compliance rate of 65%. The difference between this baseline compliance rate and the rate during the study period was significant (p < 0.0001). The compliance rate was 97% for 160 patients who underwent similar procedures during the eighteen months after completion of the study. Independent audits demonstrated continuation of the significantly better compliance with timing of antibiotic prophylaxis for patients undergoing total hip and knee arthroplasty since the implementation of the protocol in our institution. CONCLUSIONS Piggybacking of verification of prophylactic antibiotic administration onto the wrong-site-surgery time-out protocol is an effective, cost-free, and easy-to-adopt method to ensure compliance with appropriate timing of prophylactic antibiotics.
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Affiliation(s)
- Andrew D Rosenberg
- NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
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36
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Doonquah L, Doonquah L. Infection, host resistance, and antimicrobial management of the surgical patient. Oral Maxillofac Surg Clin North Am 2007; 18:173-84, vi. [PMID: 18088821 DOI: 10.1016/j.coms.2005.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chemotherapeutic management of the microbial milieu that impacts patients undergoing surgery is profoundly important in surgery involving the head and neck region. This region is a repository for a diverse population of microbes, which stand ready to invade the underlying structures once the barriers have been breached. This article evaluates human resistance to these microorganisms and reviews conditions that may increase susceptibility in patients undergoing surgery.
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Affiliation(s)
- Ladi Doonquah
- University Hospital of the West Indies, Kingston, Jamaica.
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37
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Koopman E, Nix DE, Erstad BL, Demeure MJ, Hayes MM, Ruth JT, Matthias KR. End-of-procedure cefazolin concentrations after administration for prevention of surgical-site infection. Am J Health Syst Pharm 2007; 64:1927-34. [PMID: 17823104 DOI: 10.2146/ajhp070047] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The adequacy of end-of-procedure free cefazolin concentrations after administration for the prevention of surgical-site infection (SSI) and compliance with national guidelines for antimicrobial prophylaxis for SSI were assessed. METHODS Patients undergoing elective surgery and receiving cefazolin for perioperative antimicrobial prophylaxis were prospectively enrolled. Antibiotic administration was controlled by the surgeon and usage was recorded. For each patient, a single blood sample for cefazolin serum free and total concentrations was obtained within 15 minutes of wound closure. A free serum concentration threshold of 4 microg/mL was arbitrarily chosen based on the minimum inhibitory concentration required to inhibit 90% of strains of methicillin-susceptible Staphylococcus aureus and Escherichia coli. RESULTS Fifty-seven subjects were enrolled, and noncompliance with published guidelines was observed for 26% of patients. Forty-six subjects had serum samples available for assay, 21.7% of whom had end-of-procedure free cefazolin concentrations of <4 microg/mL. Results of multivariate regression and population pharmacokinetic analysis revealed the importance of age and lean body weight in cefazolin clearance. Younger and taller patients had a greater risk of achieving below-threshold end-of-procedure concentrations. Of the patients for whom published guidelines were not followed, 67% had end-of-procedure free cefazolin concentrations below the threshold concentration (4 microg/mL). In contrast, less than 15% of cases where SSI prophylaxis complied with the published guidelines had below-threshold concentrations at the end of surgery. CONCLUSION Noncompliance with antimicrobial prophylaxis guidelines was associated with low end-of-procedure antibiotic levels. Compliance with guidelines did not guarantee adequate levels.
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Affiliation(s)
- Erin Koopman
- Saint Mary's Hospital, Mayo Clinic, Rochester, MN, USA
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38
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Bond CAC, Raehl CL. Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients. Am J Health Syst Pharm 2007; 64:1935-42. [PMID: 17823105 DOI: 10.2146/ajhp060631] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The associations between pharmacist-managed antimicrobial prophylaxis in Medicare patients who had surgical codes indicative of the need for antimicrobial prophylaxis and the major health care outcomes of death rate, length of stay, Medicare charges, drug charges, laboratory charges, and complications were explored. METHODS Pharmacist management of antimicrobial prophylaxis was evaluated in 242,704 Medicare patients from 860 [corrected] hospitals. RESULTS Patients who developed a surgical-site infection (SSI) had a 331.58% increased risk of death compared with patients who did not develop an SSI (chi2 = 743.471; df = 1; p < 0.0001; odds ratio [OR], 3.62; 95% confidence interval [CI], 3.28-3.99). Patients who developed an SSI also had a 167.16% increase in length of stay, 136.49% increase in total Medicare charges, 245.96% increase in drug charges, and 187.14% increase in laboratory charges. In hospitals without pharmacist-managed antimicrobial prophylaxis, death rates were 52.06% higher (105 excess deaths; p < 0.0001; OR, 1.54; 95% CI, 1.46-1.63), length of stay was 10.21% higher (167,941 excess patient days, p < 0.0001), mean +/- S.D. total Medicare charges were 3.10% higher ($980 +/- $1,109 more per patient) ($182,113,400 excess total Medicare charges, p < 0.0001), mean +/- S.D. drug charges were 7.24% higher ($292 +/- $492 more per patient) ($54,262,360 excess drug charges, p = 0.005), mean +/- S.D. laboratory charges were 2.72% higher ($74 +/- $151 more per patient) ($13,751,420 excess laboratory charges, p = 0.0056), and SSIs were 34.30% higher (chi2 = 95.48; df = 1; p < 0.0001; OR, 1.52; 95% CI, 1.40-1.66). CONCLUSION The provision of pharmacist-managed antimicrobial prophylaxis was associated with significant improvement in clinical and economic outcomes for Medicare patients with a surgical code indicative of the need for antimicrobial prophylaxis.
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Affiliation(s)
- C A Cab Bond
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center-Amarillo, 79106, USA.
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Yoshida M, Nabeshima T, Gomi H, Lefor AT. Technology and the prevention of surgical site infections. JOURNAL OF SURGICAL EDUCATION 2007; 64:302-310. [PMID: 17961890 DOI: 10.1016/j.jsurg.2007.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 05/24/2007] [Accepted: 08/14/2007] [Indexed: 05/25/2023]
Affiliation(s)
- Makiko Yoshida
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
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[Prevention of postoperative surgical wound infection: recommendations of the Hospital Hygiene and Infection Prevention Committee of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:377-93. [PMID: 17340231 DOI: 10.1007/s00103-007-0167-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Askarian M, Reza Moravveji A, Assadian O. Prescription of prophylactic antibiotics for neurosurgical procedures in teaching hospitals in Iran. Am J Infect Control 2007; 35:260-2. [PMID: 17482997 DOI: 10.1016/j.ajic.2006.04.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 04/26/2006] [Accepted: 04/27/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND To assess the appropriateness of surgical antibiotic prophylaxis in neurosurgical procedures, using the American Society of Health-System Pharmacists (ASHP) guideline as reference, 110 patients were prospectively evaluated. Monitoring surgical antibiotic prophylaxis is crucial in ensuring appropriate use of antimicrobial agents in this setting. This will minimize the consequences of antibiotic misuse such as increased drug antibiotic resistance, adverse events, and higher costs to the institution. METHODS We recruited 110 consecutive patients undergoing clean neurosurgical treatment in 2 hospitals. Data were collected prospectively from patients' medical records between February 2004 and April 2004. The data collection forms for each patient included hospital name, patient demographics, type of surgery, and type of antimicrobial prophylaxis regimen (drug name, dose, interval, route of administration, number of doses and time administered, and duration of administration). RESULTS Discrepancies about antibiotic selection, duration, and start time of prophylaxis were seen between current administration and the ASHP guideline. The direct cost of prophylactic antibiotics for the 110 procedures was 14 times greater than what it would have cost to administer prophylactic antibiotics adhering to the ASHP guideline (US $802 vs US $59; US $7.29 vs US $0.54 per patient, respectively). This is equivalent to US $6.75 of extra costs per procedure and patient. CONCLUSION This study indicates the need for interventions to improve the rational use of antibiotic prophylaxis in Iran to prevent the complications of inappropriate administration of antimicrobials and decrease unnecessary costs.
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Affiliation(s)
- Mehrdad Askarian
- Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Dellinger EP. Prophylactic Antibiotics: Administration and Timing before Operation Are More Important than Administration after Operation. Clin Infect Dis 2007; 44:928-30. [PMID: 17342643 DOI: 10.1086/512198] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 12/11/2006] [Indexed: 11/04/2022] Open
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Hawn MT, Gray SH, Vick CC, Itani KM, Bishop MJ, Ordin DL, Houston TK. Timely Administration of Prophylactic Antibiotics for Major Surgical Procedures. J Am Coll Surg 2006; 203:803-11. [PMID: 17116547 DOI: 10.1016/j.jamcollsurg.2006.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 08/02/2006] [Accepted: 08/04/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prophylactic antibiotics (PA) given within 60 minutes before surgical incision decrease risk of subsequent surgical site infection. Nationwide quality improvement initiatives have focused on improving the proportion of patients who receive timely prophylactic antibiotics. STUDY DESIGN This is a cohort study of major surgical procedures performed in 108 Veterans Affairs hospitals between January and December 2005. Using data from the External Peer Review Program and the National Surgical Quality Improvement Program, we examined factors associated with timely PA administration. Univariate and multivariable analyses were performed. RESULTS There were 8,137 major surgical procedures: cardiac (2,664), hip and knee arthroplasty (3,603), colon (1,142), arterial vascular (606), and hysterectomy (122). Timely PA occurred in 76.2% of patients, 18.2% received them too early, and 5.4% received them too late. Early administration accounted for 79% of untimely PA. Differences in timeliness were seen by procedure type (68% to 87%; p < 0.0001), admission status (67% to 80%; p < 0.0001), and antibiotic class (65% to 89%; p < 0.0001). PA administration occurred in the operating room for 63.5% of patients. When PA administration occurred in the operating room, they were timely in 89% of patients, compared with 54% of patients where administration was outside the operating room (odds ratio, 7.74; 95% CI = 6.49 to 9.22). CONCLUSIONS Early PA administration accounted for the majority of inappropriately timed PA. Efforts to improve performance on this measure should focus on administering antibiotics in the operating room.
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Affiliation(s)
- Mary T Hawn
- Deep South Center for Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL 35294, USA.
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Webb ALB, Flagg RL, Fink AS. Reducing surgical site infections through a multidisciplinary computerized process for preoperative prophylactic antibiotic administration. Am J Surg 2006; 192:663-8. [PMID: 17071203 DOI: 10.1016/j.amjsurg.2006.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 08/03/2006] [Accepted: 08/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) result in significant postoperative morbidity and mortality. Although many of these infections can be prevented by timely administration of preoperative antibiotics, data suggest that many patients do not receive such therapy. METHODS A multidisciplinary team was convened that reviewed published guidelines, made antibiotic recommendations, and addressed administration issues. Responsibility for antibiotic administration was shifted from preoperative nursing staff to the anesthetist. Electronic quick orders were developed to encourage appropriate antibiotic selection and simplify order creation. RESULTS Timely administration of preoperative antibiotics improved from 51% to 98% from February 2005 to February 2006. Appropriate antibiotic administered improved from 78% to 94%. The clean wound infection rate decreased from 2.7% to 1.4% over the same time period. CONCLUSION A multidisciplinary approach to prophylactic antibiotic use, including computer-guided decision support, facilitates appropriate preoperative antibiotic use, resulting in a significant decrease in surgical wound infections.
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Affiliation(s)
- Alexandra L B Webb
- Department of Surgery, Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, USA.
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45
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Kasatpibal N, Nørgaard M, Sørensen HT, Schønheyder HC, Jamulitrat S, Chongsuvivatwong V. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand. BMC Infect Dis 2006; 6:111. [PMID: 16836755 PMCID: PMC1553447 DOI: 10.1186/1471-2334-6-111] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Accepted: 07/12/2006] [Indexed: 12/13/2022] Open
Abstract
Background No data currently exist about use of antibiotics to prevent surgical site infections (SSI) among patients undergoing appendectomy in Thailand. We therefore examined risk factors, use, and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy. Methods From July 1, 2003 to June 30, 2004 we conducted a prospective cohort study in eight hospitals in Thailand. We used the National Nosocomial Infection Surveillance (NNIS) system criteria to identify SSI associated with appendectomy. We used logistic regression analysis to obtain relative risk estimates for predictors of SSI. Results Among 2139 appendectomy patients, we identified 26 SSIs, yielding a SSI rate of 1.2 infections/100 operations. Ninety-two percent of all patients (95% CI, 91.0–93.3) received antibiotic prophylaxis. Metronidazole and gentamicin were the two most common antibiotic agents, with a combined single dose administered in 39% of cases. In 54% of cases, antibiotic prophylaxis was administered for one day. We found that a prolonged duration of operation was significantly associated with an increased SSI risk. Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively. Compared with no antibiotic prophylaxis, SSI relative risks for combined single-dose of metronidazole and gentamicin, one-day prophylaxis, and multiple-day antibiotic prophylaxis were 0.28 (0.09–0.90), 0.30 (0.11–0.88) and 0.32 (0.10–0.98), respectively. Conclusion Single-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively.
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Affiliation(s)
- Nongyao Kasatpibal
- Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark
- Department of Fundamental Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Silom Jamulitrat
- Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Bernstein J, Meller MM. Antimicrobial prophylaxis to prevent surgical site infection. J Bone Joint Surg Am 2006; 88:1149-50; discussion 1150-2. [PMID: 16651591 DOI: 10.2106/jbjs.e.01221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph Bernstein
- Philadelphia Veterans Hospital, 424 Stemmler Hall, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Allen JW, Acosta J, Casós SR, Baldwin LL, Cacchione RN, Rodriguez JL. Cefotetan-induced hemolytic anemia after bariatric procedures. Surg Obes Relat Dis 2006; 2:393-6. [PMID: 16925360 DOI: 10.1016/j.soard.2006.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/01/2006] [Accepted: 03/22/2006] [Indexed: 01/24/2023]
Affiliation(s)
- Jeff W Allen
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA
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Warters RD, Szmuk P, Pivalizza EG, Gebhard RE, Katz J, Ezri T. The Role of Anesthesiologists in the Selection and Administration of Perioperative Antibiotics: A Survey of the American Association of Clinical Directors. Anesth Analg 2006; 102:1177-82. [PMID: 16551920 DOI: 10.1213/01.ane.0000195551.35172.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The importance of timely administration of antibiotics for prophylaxis of surgical site infections has led to pressure on anesthesiologists to administer antibiotics. We present a survey of members of the American Association of Clinical Directors designed to evaluate the role of the anesthesiologist in the selection and administration of perioperative antibiotics. A 13-question survey was sent via e-mail to all 233 members of the American Association of Clinical Directors. Two requests for survey responses resulted in a response rate of 43%. Based on the responses received, anesthesiologists appear to be integrally involved with the administration, but not selection, of perioperative antibiotics, despite what respondents perceive as inadequate training in antibiotic therapy. Furthermore, perioperative antibiotic therapy in general appears to be poorly monitored, and responsibility for selection and administration of perioperative antibiotics appears to be poorly defined.
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Affiliation(s)
- R David Warters
- Department of Anesthesiology, The University of Texas Medical School at Houston, USA.
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Tan JA, Naik VN, Lingard L. Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care 2006; 15:32-8. [PMID: 16456207 PMCID: PMC2563990 DOI: 10.1136/qshc.2004.012534] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections. METHODS 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the timely administration of prophylactic antibiotics. Using a grounded theory approach, transcripts were analyzed for recurrent themes. RESULTS Despite having knowledge of guidelines, participants perceived consistent failure in the proper timing of antibiotic administration. Thematic analysis revealed a number of obstacles to the observance of guidelines including: (1) low priority, (2) inconvenience, (3) workflow, (4) organizational communication, and (5) role perception. Workflow and role perception were the dominant obstacles. CONCLUSION This study suggests that proper antibiotic timing is thwarted by significant obstacles. The gap between evidence-based guidelines and practice is populated by individual values, professional conflicts, and organizational conflicts which must be addressed in order to achieve optimal practice in this domain. Using group interviews to reveal these factors to team members and managers may be a first step to resolving the gap and reducing surgical site infections.
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Affiliation(s)
- J A Tan
- University of Toronto, Toronto, Ontario, Canada.
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Carlès M, Gindre S, Aknouch N, Goubaux B, Mousnier A, Raucoules-Aimé M. Improvement of surgical antibiotic prophylaxis: a prospective evaluation of personalized antibiotic kits. J Hosp Infect 2006; 62:372-5. [PMID: 16337311 DOI: 10.1016/j.jhin.2005.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 09/06/2005] [Indexed: 11/17/2022]
Abstract
This prospective study compared personalized surgical antibiotic prophylaxis kits (SAPKs) with freely prescribed antibiotics. SAPKs use significantly enhanced national guidelines on surgical antibiotic prophylaxis application (82% vs 41%, P < 0.001), and result in limited errors in terms of antibiotic choice (3% vs 28%, P < 0.001), timing of administration (12% vs 24%, P = 0.003) and prophylaxis duration (1.5% vs 22%, P < 0.001), thereby demonstrating their effectiveness.
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Affiliation(s)
- M Carlès
- Department of Anaesthesia, University Hospital of Nice, Nice, France.
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