Process for improving antibiotic prophylaxis among surgical patients

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) and other organizations recommend that antibiotic prophylaxis for specific surgical procedures be administered 1 hour or less prior to incision. Infection control (IC) in one hospital spearheaded the process to meet this goal. METHODS: In 2002, IC initiated the process by evaluating antibiotic prophylaxis for total hip arthroplasty (THA) and total knee arthroplasty (TKA). The following interventions were implemented based on interval reviews of compliance data: 1) April 2003: orthopedic surgeons took responsibility for administering prophylaxis. 2) September 2003: standing orders written for pre-operative holding area nurses to give prophylaxis for THAs, TKAs, and cholecystectomies; antibiotics stocked in pre-operative holding, and pharmacist assigned to the operating room (OR). 3) April 2004: anesthesia began administering prophylaxis to above three procedures. 4) September 2004: anesthesiologists began administering antibiotics for all procedures based on surgeonsʹ orders. IC collected and presented compliance rates for each stage. In July 2004, IC began submitting data for the National Surgical Infection Prevention (SIP) study. RESULTS: IC reviewed the medical records of patients undergoing THAs and TKAs from June 1, 2002, through June 20, 2003, and found compliance was 86.7%. Compliance rates varied with each intervention but showed no improvement until the anesthesiologists began administering antibiotics. From April through June 2004, compliance for THAs and TKAs rose to 97.1% and increased for cholecystectomies from 70.3% to 86.6%. Since the anesthesiologists began administering prophylaxis for all procedures, SIP data has shown a steady increase in compliance rates. Compliance varies by surgical services. CONCLUSION: Although IC initiated the task of improving the administration of antibiotic prophylaxis to surgical patients, the success of the process was slow and depended on the cooperation of many departments. Data clearly showed that the most successful intervention was having anesthesia initiate prophylaxis in the operating room. IC and pharmacy continue to work with anesthesiologists, surgeons, nurses, and administration to improve infusion of prophylaxis within an hour of incision, to select appropriate antibiotics, to discontinue prophylaxis within 24 hours after surgery, and to develop computerized order sets for surgical prophylaxis.