Department of Anesthesiology, Eglin Air Force Base Hospital, Eglin AFB, FL 32542, USA.
Department of Anesthesiology, Brooke Army Medical Center, San Antonio, TX 78234, USA.
Mil Med. 2023 Jul 22;188(7-8):e1854-e1858. doi: 10.1093/milmed/usad016.
Surgical site infections complicate 2%-5% of surgeries. According to the Centers for Disease Control and Prevention, half of all surgical site infections are preventable. Adherence to published recommendations regarding perioperative antibiotic administration decreases the incidence of surgical site infections. Members of the Department of Anesthesia noticed casual observations of inaccurate prescribing of antibiotics at our institution, Brooke Army Medical Center, and approached the Antimicrobial Stewardship Program to collaborate on this issue.
A team of anesthesiologists, clinical pharmacists, and infectious disease specialists collaborated with the Department of Surgery to improve this effort as part of a multiyear project from 2018 to 2021. We first assessed adherence to recommended perioperative antibiotic use to establish a baseline and next, noticing gaps, created a project with the goal to improve compliance to >90% across surveyed measures. Our key interventions included educational initiatives, creation of facility-specific guidelines, peer benchmarking, updating order sets, interdisciplinary collaboration, creation of intraoperative reminders and visual aids, and tailored presentations to selected services.
Of 292 charts (2.3% of cases from January to October 2018) reviewed pre-intervention, compliance rates were 84% for antibiotic choice, 92% for dose, 65% for redosing, and 71% for postoperative administration. Of doses, 100% were timed correctly, and thus, this variable was not targeted. Post-intervention, our review of 387 charts (10% of cases from May to November 2020) showed no change in correct antibiotic choice (84%) and statistical improvement to 96% for correct dose, 95% for correct redosing, and 85% for correct postoperative administration (P < .05 for all).
Our multidisciplinary approach of collaboration with multiple departments, creating guidelines and providing feedback, improved compliance with perioperative antibiotic administration recommendations.
手术部位感染会使 2%-5%的手术复杂化。根据疾病控制与预防中心的数据，所有手术部位感染中有一半是可以预防的。遵守关于围手术期抗生素使用的已发表建议可降低手术部位感染的发生率。麻醉科成员注意到我们机构（布洛克陆军医疗中心）的抗生素处方不准确的随意观察，并与抗菌药物管理计划合作解决这个问题。
一组麻醉师、临床药师和传染病专家与外科合作，作为 2018 年至 2021 年多年项目的一部分，共同努力改进这一工作。我们首先评估了围手术期抗生素使用的依从性，以建立基线，然后注意到差距，制定了一个项目，目标是提高调查措施的依从率>90%。我们的主要干预措施包括教育举措、制定特定于设施的指南、同行基准测试、更新医嘱集、跨学科合作、创建术中提醒和视觉辅助工具，以及向选定的服务定制演示。
在干预前，我们审查了 292 份病历（2018 年 1 月至 10 月的 2.3%病例），抗生素选择的依从率为 84%，剂量为 92%，重剂量为 65%，术后管理为 71%。在剂量方面，100%的剂量都按时使用，因此这个变量没有作为目标。在干预后，我们审查了 387 份病历（2020 年 5 月至 11 月的 10%病例），正确抗生素选择的比例没有变化（84%），正确剂量、正确重剂量和正确术后管理的比例分别提高到 96%、95%和 85%（所有指标均为 P<.05）。
我们与多个部门合作，采用多学科方法，制定指南并提供反馈，提高了围手术期抗生素使用建议的依从性。
