Near-miss event assessment in orthopedic surgery: Antimicrobial prophylaxis noncompliance

Abstract

Level IV, Decision Analyses Study.

Using “Near Misses” Analysis to Prevent Wrong‐Site Surgery

“…Orthopedic analysis of near misses and root causes is rare and has previously been reported regarding noncompliance with antimicrobial prophylaxis (Bonfait, Delaunay, de Thomasson, & Charrois, 2010). As such, this report is amongst the first in the orthopedic literature that demonstrates the efficacy of a near-miss analysis system.…”

Reinforcing good practice: Implementation of guidelines at hospital G. Pini

“…A French study in which surgeons were interviewed about the reasons for non-adherence to antibiotic GLs showed that the GLs were tailored to meet clinical needs and that non-application was because of negligence or lack of organisation [34]. It is therefore important to encourage all staff members to focus on organisational issues and to be involved in, or aware of, the assignment of specific responsibilities [52].…”

“…Consequently, first generation cephalosporins, such as cefazolin, are the suggested first choice drugs [21,24,29]. Several studies show that the implementation of antibiotic prophylaxis is still extremely variable, despite the presence of national, regional and local GLs; antibiotics are used excessively and often inappropriately [30][31][32][33][34][35].…”

“…A preoperative, single-dose prophylaxis is adequate [36,37]; prolongation of prophylaxis beyond the first 24 h after surgery is not justified [38][39][40][41][42][43][44][45][46][47][48]. Prolonged use of antimicrobials for prophylaxis is potentially harmful because it fosters the emergence of resistant bacterial strains, which has negative effects on the patient in terms of toxicity and possible development of Clostridium difficile infections, and on the community [49,50], and also increases healthcare costs [51,34].…”

Place de l’infection comme étiologie de reprise des prothèses totales de hanche de première intention et ses facteurs prédictifs

“…Enfin, le non-respect d'une antibioprophylaxie conforme aux protocoles des services a été rapporté dans 20 % des cas. Cette carence a déjà été relevée dans les enquêtes réalisées par Orthorisq et pourrait être améliorée par la pratique de la « check-list » proposée par la Haute Autorité de santé [28,29].…”