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

Abstract

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.

Evaluation of Pediatric Surgical Site Infections Associated with Colorectal Surgeries at an Academic Children’s Hospital

“…This finding was similar to that seen in our study wherein concern for serious or severe infection prompted surgeons to unnecessarily choose broader spectrum antibiotics, thereby placing patients at risk for antibiotic resistance and fungal infections. The use of clinical decision support pathways and order sets that are incorporated into the electronic medical record may help guide antibiotic selection and prevent antibiotic overuse [14,19]. These order sets should be developed with the input of pharmacists and include optimal dosing for the chosen antibiotic, thereby potentially overcoming the AP dosing issues noted in our study.…”

“…These order sets should be developed with the input of pharmacists and include optimal dosing for the chosen antibiotic, thereby potentially overcoming the AP dosing issues noted in our study. A multi-disciplinary approach including pharmacy, surgeons, nursing, and anesthesia for the development of the clinical decision support pathway may help to shed light on different perspectives of patient care and hold all members of the patient care team accountable for ensuring appropriate use of AP [14,19,20].…”

Fear and hierarchy: critical influences on antibiotic decision-making in the operating theatre

“…What is currently being done to address SAP internationally? Successful interventions to improve SAP prescribing include studies in both resource limited and resource rich settings, and include the collaborative development of guidelines, data collection on compliance with guidelines and quality assurance cycles with audit and direct prescriber feedback [7,[9][10][11]. However, in both contexts suboptimal SAP prescribing persists, and barriers to implementation are evident, including the enduring belief within surgery regarding the benefit of post-operative SAP administration to prevent SSI [10,12,13].…”

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

“…The main characteristics of all 40 included studies are presented in Table 2. Twenty-five studies were performed in the US [36, 37, 39, 45-52, 55, 56, 58-60, 62, 63, 65, 67, 69-73], two each in Australia [34,54], Canada [41,42], the Netherlands [38,44], Spain [40,64], and the UK [35,66], and one each in Germany [68], Saudi Arabia [53], Singapore [57], Switzerland [61], and Qatar [43]. Thirty-six studies were single-center studies, and four studies were performed in more than one hospital [50,65,66,69].…”

“…In some of these studies, the compliance rates were reported in narrative or graphical form only, which made it difficult to determine the exact rates. In addition, from those studies that reported explicit baseline and cohort compliance rates, 13 studies reported rates for individual measures, while 7 presented global rates for all clinical measures [35,38,42,53,54,62,64]; only two studies reported both types of rates [34,63]. Thus, further analyses on the associations between implementation interventions and compliance with clinical interventions are omitted.…”