Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Surg Infect (Larchmt). 2023 Oct;24(8):716-724. doi: 10.1089/sur.2023.111. Epub 2023 Oct 13.
Our multi-institutional healthcare system had a higher-than-expected surgical site infection (SSI) rate. We aimed to improve our peri-operative antibiotic administration process. Gap analysis identified three opportunities for process improvement: standardized antibiotic selection, standardized second-line antibiotic agents for patients with allergies, and feedback regarding antibiotic administration compliance. Implementation of a multifaceted quality improvement initiative including a near-real-time pre-operative antibiotic compliance feedback tool will improve compliance with antibiotic administration protocols, subsequently lowering SSI rate. A compliance feedback tool designed to provide monthly reports to all anesthesia and surgical personnel was implemented at two facilities, in September 2017 and December 2018. Internal case data were tracked for antibiotic compliance through June 2021, and these data were merged with American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data at the case level to provide process and outcome measures for SSIs. Implementation success was evaluated by comparing protocol compliance and risk-adjusted rates of superficial and deep SSI before and after the quality improvement implementation. A total of 20,385 patients were included in this study; 11,548 patients in the pre-implementation and 8,837 in the post-implementation groups. Baseline patient and operative characteristics were similar between groups, except the post-implementation group had a higher median expected SSI rate (2.2% vs. 1.6%). Post-implementation, antibiotic protocol compliance increased from 86.3% to 97.6%, and superficial and deep SSIs decreased from 2.8% to 1.9% (p < 0.001). The odds of superficial and deep SSI in patients in the post-implementation group was 0.69 (0.57, 0.83) times the odds of superficial and deep SSI in pre-implementation patients while adjusting for age, gender, diabetes mellitus, American Society of Anesthesiologists Physical Status (ASA) classification, wound class, smoking, and chronic obstructive pulmonary disease (COPD). Observed-to-expected ratios of superficial and deep SSI decreased from 0.82 to 0.48 after the intervention. Surgical antibiotic prophylaxis standardization and providing near-real-time individualized feedback resulted in sustained improvement in peri-operative antibiotic compliance rates and reduced superficial and deep SSIs.
我们的多机构医疗体系的手术部位感染（SSI）发生率高于预期。我们旨在改进围手术期抗生素管理流程。差距分析确定了三个流程改进的机会：标准化抗生素选择、过敏患者的标准化二线抗生素药物以及抗生素使用依从性的反馈。实施包括术前抗生素使用依从性实时反馈工具在内的多方面质量改进措施，将提高抗生素使用规范的依从性，从而降低 SSI 发生率。2017 年 9 月和 2018 年 12 月，在两家机构实施了一种设计用于向所有麻醉和外科人员提供每月报告的依从性反馈工具。2021 年 6 月之前，通过内部病例数据跟踪抗生素的依从性，并且这些数据与美国外科医师学院国家外科质量改进计划（ACS-NSQIP）的病例数据进行了合并，以提供 SSI 的过程和结果指标。通过比较质量改进实施前后的方案依从性和调整风险后的浅层和深层 SSI 发生率来评估实施的成功。这项研究共纳入 20385 例患者，其中实施前 11548 例，实施后 8837 例。两组患者的基线特征和手术特征相似，除了实施后组的预期 SSI 发生率较高（2.2%比 1.6%）。实施后，抗生素方案的依从性从 86.3%提高到 97.6%，浅层和深层 SSI 从 2.8%下降到 1.9%（p<0.001）。实施后组患者浅层和深层 SSI 的发生率是实施前组的 0.69 倍（0.57 至 0.83），调整年龄、性别、糖尿病、美国麻醉师协会身体状况分类、伤口类型、吸烟和慢性阻塞性肺疾病（COPD）后。干预后浅层和深层 SSI 的观察到的预期比值从 0.82 下降到 0.48。外科抗生素预防规范化和提供实时个体化反馈，持续提高围手术期抗生素使用规范的依从性，降低浅层和深层 SSI 的发生率。
