Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis

Gina Riggi, Mayela Castillo, Margaret Fernandez, Andrew Wawrzyniak, Michael Vigoda, Scott Eber, David Lubarsky, Lilian M. Abbo

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1236-1240
Number of pages5
JournalInfection Control and Hospital Epidemiology
Volume35
Issue number10
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Compliance
Orthopedic Procedures
Neurosurgical Procedures
Microbial Sensitivity Tests
Organ Transplantation
Patient Safety
Teaching Hospitals
Health Personnel
Guidelines
Education

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Riggi, G., Castillo, M., Fernandez, M., Wawrzyniak, A., Vigoda, M., Eber, S., ... Abbo, L. M. (2014). Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis. Infection Control and Hospital Epidemiology, 35(10), 1236-1240. https://doi.org/10.1086/678058

Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis. / Riggi, Gina; Castillo, Mayela; Fernandez, Margaret; Wawrzyniak, Andrew; Vigoda, Michael; Eber, Scott; Lubarsky, David; Abbo, Lilian M.

In: Infection Control and Hospital Epidemiology, Vol. 35, No. 10, 01.01.2014, p. 1236-1240.

Research output: Contribution to journalArticle

Riggi, G, Castillo, M, Fernandez, M, Wawrzyniak, A, Vigoda, M, Eber, S, Lubarsky, D & Abbo, LM 2014, 'Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis', Infection Control and Hospital Epidemiology, vol. 35, no. 10, pp. 1236-1240. https://doi.org/10.1086/678058
Riggi, Gina ; Castillo, Mayela ; Fernandez, Margaret ; Wawrzyniak, Andrew ; Vigoda, Michael ; Eber, Scott ; Lubarsky, David ; Abbo, Lilian M. / Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis. In: Infection Control and Hospital Epidemiology. 2014 ; Vol. 35, No. 10. pp. 1236-1240.
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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.",
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AU - Eber, Scott

AU - Lubarsky, David

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