Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures

Abstract

Postoperative wound infections represent an important source of morbidity and mortality in children. Perioperative antibiotic prophylaxis has been shown to decrease the risk of developing infections and hospital guidelines surrounding antibiotic use exist to standardize patient care. Despite supporting evidence, rates of compliance with guidelines vary. Quality improvement initiatives have been introduced to improve compliance with intraoperative antibiotic guidelines. Thorough infection surveillance, including antibiotic provision in presurgical checklists, computerized voice antibiotic administration prompts, and national feedback systems are now increasingly common. Few studies have been conducted investigating the effectiveness of prophylactic antibiotics in children. Outcome measures such as morbidity and mortality and return to the operating room can be used to examine the relationship between antibiotic use and patient outcome but these measures are limited in that they occur infrequently or are subjective and difficult to measure. Metrics such as days alive out of hospital and length of hospital stay may be useful alternatives for ongoing monitoring of infections and identifying improvements in patient outcomes. Guidelines on antibiotic prophylaxis have facilitated an increase in the correct provision of perioperative antibiotics and a reduction in the incidence of postoperative infection. Measures of patient outcome such as days alive out of hospital and length of hospital stay are easy to collect and calculate but further work is needed to confirm the utility of these measures for monitoring infection rates.

Diagnosis and perioperative management in pediatric sleep‐disordered breathing

“…Sir Adrenal insufficiency is characterized by the deficiency of circulating adrenocortical hormones and can be primary or central. 1 Primary adrenal insufficiency is due to disease of the adrenal cortex, central adrenal insufficiency to a deficit in hypothalamic/pituitary secretion of adrenocorticotropic hormone. 1 Patients with adrenal insufficiency require basal steroid replacement and need supplemental glucocorticoids during periods of medical stress.…”

“…1 Primary adrenal insufficiency is due to disease of the adrenal cortex, central adrenal insufficiency to a deficit in hypothalamic/pituitary secretion of adrenocorticotropic hormone. 1 Patients with adrenal insufficiency require basal steroid replacement and need supplemental glucocorticoids during periods of medical stress. 2 Their inability to mount normal physiologic responses to stress may lead to adrenal crisis, a life-threatening condition.…”

Intraoperative antibiotic redosing compliance and the extended postoperative recovery period: Often overlooked areas that may reduce surgical site infections

“…3 Maintaining adequate inhibitory antimicrobial plasma and tissue levels during surgery depends not just on the initial dose but also on subsequent redosing. 1,4 The Centers for Disease Control (CDC), the Infectious Disease Society of America (IDSA), and the American Society of Health-System Pharmacists (AHSP) recommend redosing when the procedure length exceeds one to two half-lives of the antibiotic. 4 But, there are no standard guidelines for reporting redose compliance, unlike the SCIP measures that include first dose compliance.…”

“…Given its prevalence and the importance of redosing, we challenge the convention of redosing cefazolin every 4 hours, as cited in Morse's review as the recommendation from the AHSP. 1,4 The recommended redosing guidelines from the CDC, AHSP, and IDSA are to redose antibiotics every two half-lives. 4 Given that the half-life of cefazolin is reported to vary from 1.2 to 2.2 hours under non-blood loss settings, we redose cefazolin every 3 hours.…”

“…4 Indeed, Figure 1 of Morse's article demonstrates the concentration of cefazolin falling below the minimum inhibitory concentration prior to 4 hours. 1 Perhaps not surprisingly, SSIs are more common in surgeries lasting greater than 3 hours when a single dose of cefazolin is used. 4 Finally, it is common for SSIs and perioperative antibiotics to be discussed in tandem since antibiotics have been convincingly shown to reduce the risk of SSIs.…”