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Improving Compliance with Timely Intraoperative Redosing of Antimicrobials in Surgical Prophylaxis

Published online by Cambridge University Press:  10 May 2016

Gina Riggi ,
Mayela Castillo ,
Margaret Fernandez ,
Andrew Wawrzyniak ,
Michael Vigoda ,
Scott Eber ,
David Lubarsky  and
Lilian M. Abbo
Gina Riggi
Affiliation:
Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida
Mayela Castillo
Affiliation:
Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida
Margaret Fernandez
Affiliation:
Department of Pharmacy, Jackson Memorial Hospital, Miami, Florida
Andrew Wawrzyniak
Affiliation:
School of Nursing and Health Studies, University of Miami Miller School of Medicine, Miami, Florida Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
Michael Vigoda
Affiliation:
Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
Scott Eber
Affiliation:
Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
David Lubarsky
Affiliation:
Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
Lilian M. Abbo*
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
*
University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Suite 851, Miami, FL 33136 ([email protected]).
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Abstract

Background.

Appropriate use of antimicrobials for surgical prophylaxis is an important patient safety issue. Antimicrobial levels should be present during the duration of the surgical procedure until incision site closure. For prolonged surgical procedures in which the tissue concentration of the prophylactic antimicrobial may decrease to below the necessary minimum inhibitory concentration, intraoperative redosing of antimicrobials may be crucial

Objective.

To evaluate compliance of appropriate intraoperative antimicrobial surgical prophylaxis using real-time intraoperative antimicrobial dosing reminders at a large teaching hospital.

Methods.

A retrospective review of electronic records (March 2009–October 2012) was performed. Patients were included if they were at least 18 years of age and underwent a procedure requiring antimicrobial surgical prophylaxis. Compliance was determined by comparing 3 time intervals: baseline (March 2009–March 2010); intervention period 1 (IP-1; April 1, 2010–April 30, 2012), and intervention period 2 (IP-2; May 1, 2012–October 31, 2012). Interventions included a hospital-wide standardized protocol comprising an automated intraoperative paging system to notify when antimicrobials should be redosed.

Results.

A total of 7,461 of 75,230 surgical procedures required intraoperative redosing of antimicrobials and were analyzed. Patient mean age (± standard deviation) was 45 ± 19 years, and 62.6% were female. The most common procedures that required prophylaxis were solid organ transplantation, neurosurgical procedures, and orthopedic procedures. Baseline compliance (n = 2,183) was 15.8%; compliance significantly improved to 65.3% during IP-1 (n = 4,486; P < .001). The compliance rate improved to 76.7% during IP-2 (P > .001 compared with no reminder).

Conclusions.

Compliance with redosing of intraoperative antimicrobials was improved with the combined approach of guidelines, education to healthcare providers, and real-time automated paging system.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1236 - 1240
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. St. Jacques, P, Sanders, N, Patel, N, Talbot, TR, Deshpande, JK, Higgins, M. Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts. Surg Infect (Larchmt) 2005;6(2):215–221.Google Scholar
2. Joint Commission. Surgical care improvement project national hospital inpatient quality measures. http://www.jointcommission.org/topics/hai_ssi.aspx. Accessed December 27, 2013.Google Scholar
3. Surgical Care Improvement Measures. Centers for Medicare and Medicaid Services. http://www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/ACEQualityMeasures.pdf. Accessed December 27, 2013.Google Scholar
4. Bratzler, DW. Surgical care improvement project performance measures: good but not perfect. Clin Infect Dis 2013;56(3):428–429.Google Scholar
5. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70(3):195–283.Google Scholar
6. Zanetti, G, Giardina, R, Platt, R. Intraoperative redosing of cefazolin and risk for surgical site infection in cardiac surgery. Emerg Infect Dis 2001;7(5):828–831.Google Scholar
7. Zelenitsky, SA, Ariano, RE, Harding, GK, Silverman, RE. Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother 2002;46(9):3026–3030.Google Scholar
8. Koopman, E, Nix, DE, Erstad, BL, et al. End-of-procedure cefazolin concentrations after administration for prevention of surgical-site infection. Am J Health Syst Pharm 2007;64(18):1927–1934.Google Scholar
9. Zanetti, G, Flanagan, HL Jr, Cohn, LH, Giardina, R, Platt, R. Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room. Infect Control Hosp Epidemiol 2003;24(1):13–16.Google Scholar
10. Steinberg, JP, Braun, BI, Hellinger, WC, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg 2009;250(1):10–16.Google Scholar