Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions

Putnam, Luke R.; Chang, Courtney M.; Rogers, Nathan; Podolnick, Jason; Sakhuja, Shruti; Matusczcak, Maria; Austin, Mary T.; Kao, Lillian S.; Lally, Kevin P.; Tsao, Kuo Jen

doi:10.1016/j.surg.2015.04.013

Cited by 34 publications

(33 citation statements)

References 19 publications

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“…Evidence for the effectiveness of SAP prescription is well established. Nevertheless, some studies suggest that optimal practice is not achieved in many hospitals . In this study, the practice of thoracic surgeons in Iran is fairly consistent with ASHP guidelines in terms of prescribing SAP.…”

Section: Discussionsupporting

confidence: 67%

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

Shadmehr

Baniasadi

2019

Pharmacy Practice and Res

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Background Surgical antibiotic prophylaxis (SAP) decreases the incidence of surgical site infections. However, inappropriate use of prophylactic antibiotics may lead to antibiotic resistance, prolonged hospital stay and adverse drug reactions. Aim This prospective study aimed to assess the concordance of prophylactic antibiotic administration for thoracic operations in Iran with American Society of Health‐System Pharmacists (ASHP) guidelines. Methods The appropriateness of SAP administration in 222 thoracic operations was assessed in a respiratory referral centre over a period of 4 months. Demographic, clinical and SAP data were recorded from patient files. ASHP guidelines were used to evaluate the appropriateness of prophylactic antibiotic administration. Results Cefazolin was correctly prescribed for approximately 70% of patients who required antibiotic prophylaxis. SAP was administered at the correct time (within 60 min before surgery) for 71.6% of surgeries. Intraoperative doses were correctly given in 27.7% of prolonged procedures. In 86.7% of surgeries, antibiotic administration was continued for more than 24 h after surgery (based on a physician's opinion or recent microbiological cultures). Conclusion The results suggest a relatively low rate of consistency between SAP administration and ASHP guidelines in Iran. A long duration of antibiotic administration after operations is an important finding, which should be considered and re‐evaluated by thoracic surgeons in Iran.

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Section: Discussionsupporting

confidence: 67%

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

Shadmehr

Baniasadi

2019

Pharmacy Practice and Res

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“…Other studies have commented on the importance of having multidisciplinary involvement in improving SAP compliance [13], [14], [15], [17], [18], [24], [25], [26]. Due to having a multidisciplinary team, a wide range of perspectives were available when deciding upon the hospital's SAP policy.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, each member of the team had a role to play in ensuring compliance with the policy: a few surgeons and anaesthesiologists functioned effectively as change agents by convincing their colleagues to follow the protocol; pharmacists decided that only antibiotics listed in SAP adapted order form would be stocked in the electronic medication dispensing cabinets; nurses were responsible for giving reminders regarding time of re-dosing in the operating room; and quality improvement staff were responsible for providing monthly feedback to the team regarding compliance with SAP. Regular feedback has also been identified as an important aspect for improving SAP compliance [14], [25], [26], [27].…”

Section: Discussionmentioning

confidence: 99%

Improving antibiotic prophylaxis in gastrointestinal surgery patients: A quality improvement project

Kilan

Moran

Eid

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundA surgical site infection (SSI) is a frequent complication following gastrointestinal surgery, but the careful selection and administration of prophylactic antibiotics can reduce the risk. The aim of this study was to develop a package of interventions that could be used to improve surgical antibiotic prophylaxis (SAP) at our institution.MethodsA pre-post quality improvement project at a private hospital in Saudi Arabia was conducted between January 2014 until July 2016. A multidisciplinary team was assembled to identify and overcome barriers that were responsible for patients receiving suboptimal antibiotic prophylaxis. Patients were included if they had undergone surgery on their appendix, colon, rectum, or small intestine. Compliance with use of an adapted order form, as well as appropriate antibiotic selection, dosing, timing, and timing of re-dosing, were measured. Data on the rates of SSI before and after the intervention were also obtained.ResultsOf the 269 patients included in the study, 161 (61.5%) had appendix surgery, 86 (32.8%) had colorectal surgery, and 15 (5.7%) had small bowel surgery. The surgery was performed laparoscopically in 218 (83.5%) of patients. Utilization of the adapted order form increased from 1.8% to 92.0% following the intervention (p < 0.001). Compliance with a bundle of appropriate antibiotic selection, dosing and timing improved from 47.3% to 82.2% after the intervention (p < 0.001). Additionally, there was a non-statistically significant reduction in SSI rate (9.1% vs 5.1%; p = 0.27).ConclusionsOur quality improvement intervention was successful in improving SAP for patients undergoing gastrointestinal surgery at our institution.

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“…Indeed, previous studies report that clinical trial participants might have limited understanding of the experimental aspect of such efforts(Nishimura et al, 2013; Putnam et al, 2015; Trantham et al, 2015) (Corbie-Smith, Thomas, Williams, & Moody-Ayers, 1999; Flory & Emanuel, 2004; Tattersall, 2001). Without clear communication about the purpose, process, and benefits of specific studies, community members might not be aware of their importance.…”

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confidence: 99%

Health Literacy and Informed Consent Materials: Designed for Documentation, Not Comprehension of Health Research

Simonds

Garroutte

Buchwald

2017

Journal of Health Communication

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Minority populations with health disparities are underrepresented in research designed to address those disparities. One way to improve minority representation is to use community-based participatory methods to overcome barriers to research participation, beginning with the informed consent process. Relevant barriers to participation include lack of individual or community awareness or acceptance of research processes and purposes. These barriers are associated with limited health literacy. To inform recommendations for an improved consent process, we examined 97 consent documents and 10 associated Institutional Review Board websites to determine their health literacy demands and degree of adherence to principles of community-based research. We assessed the reading level of consent documents and obtained global measures of their health literacy demand by using the Suitability and Comprehensibility Assessment of Materials instrument. Although these documents were deemed suitable as medical forms, their readability levels were inappropriate, and they were unsuitable for educating potential participants about research purposes. We also assessed consent forms and Institutional Review Board policies for endorsement of community-based participatory principles, finding that very few acknowledged or adhered to such principles. To improve comprehension of consent documents, we recommend restructuring them as educational materials that adhere to current health literacy guidelines.

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Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions

Cited by 34 publications

References 19 publications

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

Improving antibiotic prophylaxis in gastrointestinal surgery patients: A quality improvement project

Health Literacy and Informed Consent Materials: Designed for Documentation, Not Comprehension of Health Research

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