Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, USA; The Children's Memorial Hermann Hospital, Houston, TX, USA.
Am J Surg. 2013 Oct;206(4):451-6. doi: 10.1016/j.amjsurg.2013.02.009. Epub 2013 Jun 27.
Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.
A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.
Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.
Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.
尽管外科护理改进项目感染措施的依从性有所提高，但手术部位感染并未减少。本研究旨在检验以下假设：儿科外科服务中记录的抗生素预防用药指南的依从性并不能反映实施的保真度或是否符合预期。
进行了一项为期 7 周的择期小儿外科手术病例观察研究。评估了抗生素的合理使用、类型、时机、基于体重的剂量和重新给药。
在 143 例中，141 例（99%）给予了适当的预防用抗生素。在 100 例需要抗生素预防的病例中，电子病历中有 100%的病例记录了用药情况，但只有 48%的病例符合所有 5 项指南。不符合的主要原因是剂量或时间错误。
抗生素预防指南的实施保真度不足可能部分解释了手术部位感染预期减少的原因。未来对外科护理改进项目效果的研究应测量依从性和实施保真度，而不仅仅是记录的依从性。
