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Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room

Published online by Cambridge University Press:  02 January 2015

Giorgio Zanetti ,
Hugh L. Flanagan Jr. ,
Lawrence H. Cohn ,
Richard Giardina  and
Richard Platt
Giorgio Zanetti*
Affiliation:
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Division of Infectious Diseases, Department of Internal Medicine, University Hospital, Lausanne, Switzerland
Hugh L. Flanagan Jr.
Affiliation:
Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Lawrence H. Cohn
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Richard Giardina
Affiliation:
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
Richard Platt
Affiliation:
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, Massachusetts; and the HMO Research Network Center for Education and Research in Therapeutics
*
Division of Infectious Diseases, University Hospital, 1011 Lausanne, Switzerland
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Abstract

Objective:

To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations.

Design:

Randomized, controlled, evaluator-blinded trial.

Setting:

University-affiliated hospital.

Patients:

Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery.

Intervention:

Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered.

Results:

Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02).

Conclusion:

The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 1 , January 2003 , pp. 13 - 16
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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