Ribed Almudena, Monje Beatriz, García-González Xandra, Sanchez-Somolinos Mar, Sanz-Ruiz Pablo, Rodríguez-González Carmen Guadalupe, Sanjurjo-Saez María
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Pharmacy Department Hospital, Universitario Del Henares, Coslada, Spain.
Eur J Hosp Pharm. 2020 Jul;27(4):237-242. doi: 10.1136/ejhpharm-2018-001666. Epub 2018 Nov 26.
Infection following orthopaedic surgery is a feared complication and an indicator of the quality of the hospital. Surgical antibiotic prophylaxis (SAP) guidelines are not always properly followed. Our aim was to describe and evaluate the impact of a multidisciplinary intervention on antibiotic prophylaxis adherence to hospital guidelines and 30-day postoperative outcomes.
The study was carried out from January to May 2016 and consisted of creating a multidisciplinary team, updating institutional guidelines and embedding the recommendations in the computerised physician order entry system which is linked to dose and renal function alerts, educational activities and pharmaceutical bedside care of patients in the orthopaedic department. A prospective pre-post study was carried out in accordance with the Declaration of Helsinki. The following information was recorded: patient and surgery characteristics, adherence to SAP guidelines, surgical site infections, length of hospital stay and rate of readmission 30 days after discharge. Statistical analyses were performed using SPSS 18.0.
Eighty three orthopaedic patients of mean±SD age 68.2±17.0 years (44.6% male, 40 in the pre-intervention group and 43 in the intervention group) were included. Cefazolin was the recommended and most commonly administered antibiotic agent. In the intervention group, an improvement in global adherence to guidelines was achieved (76.7% vs 89.9%; p=0.039): antibiotic duration (75.0% vs 97.7%), correct dosage post-surgery (55.0% vs 76.7%), timing of administration (57.5% vs 72.1%), antibiotic pre-surgery prescription (92.5% vs 97.7%). Three surgical site infections were detected in the pre-intervention group and none in the intervention group (p>0.05). Length of hospital stay was reduced by 1 day and readmission decreased by 15% (p=0.038).
SAP is used in daily practice in most orthopaedic patients. The implementation of a multidisciplinary programme based on health technology improved the adherence to guidelines and appeared to reduce the readmission rate.
骨科手术后感染是一种可怕的并发症，也是医院医疗质量的一个指标。外科抗生素预防（SAP）指南并非总是得到正确遵循。我们的目的是描述和评估多学科干预措施对遵循抗生素预防指南情况及术后30天结局的影响。
该研究于2016年1月至5月进行，包括组建一个多学科团队、更新机构指南并将相关建议嵌入与剂量及肾功能警报相关联的计算机化医师医嘱录入系统、开展教育活动以及对骨科患者进行药学床边护理。按照《赫尔辛基宣言》进行了一项前瞻性前后对照研究。记录了以下信息：患者及手术特征、遵循SAP指南情况、手术部位感染、住院时间以及出院后30天的再入院率。使用SPSS 18.0进行统计分析。
纳入了83例骨科患者，平均年龄±标准差为68.2±17.0岁（男性占44.6%，干预前组40例，干预组43例）。头孢唑林是推荐且最常使用的抗生素。在干预组，全球遵循指南情况有所改善（76.7%对89.9%；p = 0.039）：抗生素使用时长（75.0%对97.7%）、术后正确剂量（55.0%对76.7%）、给药时间（57.5%对72.1%）、术前抗生素处方（92.5%对97.7%）。干预前组检测到3例手术部位感染，干预组未检测到（p>0.05）。住院时间缩短了1天，再入院率下降了15%（p = 0.038）。
大多数骨科患者在日常实践中使用SAP。基于卫生技术实施的多学科方案提高了对指南的遵循情况，且似乎降低了再入院率。
