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oregon; portland; ppmc; psvmc
Pharmacy and Pharmaceutical Sciences | Surgery
• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, the institutional SSI committee implemented quality improvement changes in July 2020. •For hysterectomies, the committee recommended adding metronidazole to cefazolin. •For colorectal surgeries, the preferred agent was changed from cefazolin plus metronidazole to ceftriaxone plus metronidazole.
Purpose To evaluate the overall compliance of SAP selection prior to incision based on guideline recommendations from the institutional SSI committee
• Assess hysterectomy and colorectal surgery peri-operative antibiotic prophylaxis for compliance from previous recommendations made by the institutional SSI committee •Measure the percent change of primary surgeon and anesthesiologist SAP selection from the pre-intervention analysis phase to post-intervention analysis phase
Institutional Review Board (IRB)-approved •Electronic health record (EHR)-based retrospective and prospective analysis of hysterectomy and colorectal surgeries performed at a tertiary medical center •Study population: •Patients ≥ 18 years old •Underwent a hysterectomy or colorectal surgery •Study period: •Pre-intervention: October 2019-March 2020 •Post intervention: July-December 2020 •April-June 2020 was excluded due to the COVID-19 pandemic •Exclusion criteria: •Underwent greater than one type of surgery •All patients meeting inclusion criteria were included •Primary outcomes: overall compliance of SAP and the percent change from the pre-to post-intervention analysis phase
Patient Population •A total of 276 patients who underwent a hysterectomy were included in the pre-intervention analysis (October 2019-March 2020) and 244 patients were included in the post-intervention analysis (July-December 2020). •For colorectal surgeries, 170 patients were included in the pre-intervention analysis and 193 patients were included in the post-intervention analysis. Clinical Outcomes Hysterectomy SAP •35% achieved the primary outcome of compliance to the system guidelines in the pre-intervention analysis. •71.6% achieved the primary outcome of compliance to the system guidelines in the post-intervention analysis. •Overall, there was a 105% change in SAP selection for hysterectomy surgeries to the guideline recommended regimen (cefazolin only to cefazolin plus metronidazole). Colorectal SAP •75.8% achieved the primary outcome of compliance to the institutional guidelines in the pre-intervention analysis (cefazolin or ceftriaxone plus metronidazole). •80.5% achieved the primary outcome of compliance to the institutional guidelines in the post-intervention analysis. •Overall, there was a 752% change in SAP selection for colorectal surgeries to the institutional preferred regimen (cefazolin to ceftriaxone). SSI Occurrence •No SSIs occurred in October-December 2019 for either procedure. •Four SSIs occurred in January-March 2020 for colorectal surgeries. All cases included cefazolin plus metronidazole. •Two SSIs occurred in July-December 2020 for colorectal surgeries. Both cases included ceftriaxone plus metronidazole. •One SSI occurred after a hysterectomy in August 2020 using the regimen cefazolin plus metronidazole. Study Limitations •Retrospective, non-randomized study •Select data was pulled from EHR via retrospective chart evaluation by single reviewer •Could not include April-June 2020 data due to the absence of elective surgeries during the start of the COVID-19 pandemic •Did not assess patients with a history of MRSA who should have received vancomycin pre-operatively
This study was performed to assess hysterectomy and colorectal surgery peri-operative antibiotic prophylaxis for compliance from previous recommendations made by the institutional SSI committee and measure the percent change from the pre-intervention analysis. •The rate of change to the recommended SAP was 105% and 752% for hysterectomy and colorectal surgeries, respectively. •There was a higher rate of error associated with the use of cefazolin in colorectal surgeries. •The rate of incorrect use of an alternative regimen for a beta-lactam allergy in hysterectomies decreased from 2.6% to 1.6% (pre-and post-intervention, respectively). •The rate of incorrect use of an alternative regimen for a beta-lactam allergy in colorectal surgeries decreased from 2.4% to 2% (pre-and post-intervention, respectively). •Four SSIs occurred in the pre-intervention phase compared to two SSIs in the post-intervention phase in colorectal surgeries. However, it is difficult to assess if antibiotic selection was the main cause of infection, as there were many other variables to consider. •Individual provider data was collected and shared internally for the purpose of quality improvement. •Additional statistical analysis is currently being assessed.
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Providence Portland Medical Center
Greckel, Meagan and Footer, Brent, "Evaluation of Surgical Antibiotic Prophylaxis Compliance at a Large, Tertiary Medical Center" (2021). Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021. 11.