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Improving appropriate time-delivery of surgical antibiotic prophylaxis
216
AJIC April 1999
Abstracts
199 minutes (SD+38). Interventions in the peri-operative period to prevent infection: dose-appropriate and timely surgical antibiotic prophylaxis (95%), early ambulation (95% <48h postoperative), indwelling urinary catheter removal (74% <48h postoperative), and intensive respiratory therapy (100%). The mean length of hospital stay was 6 days. Two superficial surgical site infections occurred in the peri-operative period. CONCLUSIONS: Careful patient selection, multi-disciplinary planning and preventive nursing measures in the peri-operative period influenced the successful outcome for this group of patients.
IMPROVING APPROPRIATE TIME-DELIVERY OF SURGICAL ANTIBIOTIC PROPHYLAXIS. P. A. May, RN, BSN,
CIC,* I. E. Luten, BSMT, (ASCP), CIC, A.Y. Darden, RN, BSN, G. Ajose, RN, BSN, I. N. Hernandez, BSMT, CIC, M. Kramer, MD. Kings County Hospital Center, Brooklyn, NY. The infection control department (ICD) had conducted monitoring and evaluation of surgical site infection (SSI) rates in gynecologic procedures regularly in the past. Based on the Centers for Disease Control and Prevention's (CDC's) recommendations for preventing SSls the ICD instituted quality improvement activities looking specifically at antibiotic prophylaxis in gynecologic operative procedures. The CDC recommends that prophylactic antibiotics be administered within two hours prior to skin incision to be maximally effective. An initial 3-month study indicated that only 2.3% (1/44) of cases received prophylactic antibiotics within the a p p r o p r i a t e time because prophylactic antibiotics were being delivered "on-call" to the operating r o o m (OR). This "on-call" m e t h o d was unacceptable since the time the antibiotic was being given was unpredictable. Infection control collaborated with the gynecologic service, anesthesia department, nursing service and quality m a n a g e m e n t d e p a r t m e n t and devised a policy and procedure to deliver prophylactic antibiotics within two hours of surgical incision as r e c o m m e n d e d by the CDC. In the revised policy, rather than give the antibiotics "oncall to the OR," the patients were to receive the antibiotics in the OR proximal to the time of anticipated skin incision. The second 3-month study yielded an 82.4% (28/34) rate of patients receiving antibiotics within the appropriate time period. A third and fourth follow-up study revealed that 98.5% (64/65) and 100% (14/14) of patients respectively, received antibiotics within two hours of surgical incision. Thus, the gains in appropriate time-delivery of antibiotic prophylaxis was significantly improved and sustained. There was also a decrease in infection rates, from 4.08% in the first study and 5.5% in the second study to 0% in the third and fourth studies. Infection control practitioners should periodically review antibiotic prophylaxis protocols to ensure that the basic principles are being followed.
AN INVESTIGATION OF SURGICAL I N F E C T I O N S REVEALS A FLUID WARMER AS A RESERVOIR FOR BACTERIA. S. Burns, BS, CIC.* Henry Ford Hospital,
Detroit, MI. BACKGROUND: During a two-week period, four patients developed bloodstream infection within 2-10 days of a neurosurgical procedure. Preliminary investigation showed each patient with different gram-negative organisms and surgery performed on different days by various surgeons. METHODS: Investigation included: 1) case definition and chart review, 2) observations to identify breaks in aseptic technique, 3) environmental cultures from all opened multi-use vials and solutions in the neurosurgica] suites, and 4) hand cultures from neurosurgical nursing staff. FINDINGS: Chart review showed no common denominator. Observation of surgical procedures revealed no breaks in aseptic technique. A questionable break in clean technique was observed in the anesthesia workroom, where an anesthetic was being reconstituted on a workbench that was used for cleaning of c o n t a m i n a t e d instruments. Environmental cultures were negative, except water from the heated reservoirs of the Hofline ~ fluid warmers. The water contained >100,000 colonies of multiple gram negative organisms. None of these organisms matched the patients' organisms. However, it was noted that an open port allowed water to spill out and potentially contaminate gloved hand(s) during use. Hand cultures were negative. RECOMMENDATIONS: Reconstitution of the anesthetic was relocated to a laminar flow hood in the pharmacy. New guidelines were established for the maintenance and use of the Hofline ® fluid warmers. CONCLUSIONS: No common source for the infections was identified, however no new infections were noted in the next several months.
INCORPORATING SURGICAL PROPHYLACTIC ANTIBIOTIC MONITORING INTO ROUTINE N N I S SURVEILLANCE: A T H R E E Y E A R E X P E R I E N C E . A.
Adams, RN, MPH, CIC,* C. Francis, RN, MPH, CIC, B. Huvane, RN, MS, CIC, K. Mullaney, RN, MPH, CIC, B. Cuttle, MD. Montefiore Medical Center, Bronx, NY. In an effort to optimize surgical prophylaxis patterns at our 650-bed teaching hospital in a cost-effective manner, monitoring of prophylactic antibiotic usage was incorporated into the surgical surveillance component of the National Nosocomial Infection Surveillance (NNIS) system in 1995. Minor alterations in data collection forms provided a costeffective means of evaluating prophylactic use patterns which were effectively used to provide feedback to surgeons. Observed patterns of prophylaxis including selection of agent, timing, and duration were compared to institutional standards adopted from national guidelines. Patterns of improvement varied by surgical service. There was a 25.3%
AJIC April 1999
Abstracts
199 minutes (SD+38). Interventions in the peri-operative period to prevent infection: dose-appropriate and timely surgical antibiotic prophylaxis (95%), early ambulation (95% <48h postoperative), indwelling urinary catheter removal (74% <48h postoperative), and intensive respiratory therapy (100%). The mean length of hospital stay was 6 days. Two superficial surgical site infections occurred in the peri-operative period. CONCLUSIONS: Careful patient selection, multi-disciplinary planning and preventive nursing measures in the peri-operative period influenced the successful outcome for this group of patients.
IMPROVING APPROPRIATE TIME-DELIVERY OF SURGICAL ANTIBIOTIC PROPHYLAXIS. P. A. May, RN, BSN,
CIC,* I. E. Luten, BSMT, (ASCP), CIC, A.Y. Darden, RN, BSN, G. Ajose, RN, BSN, I. N. Hernandez, BSMT, CIC, M. Kramer, MD. Kings County Hospital Center, Brooklyn, NY. The infection control department (ICD) had conducted monitoring and evaluation of surgical site infection (SSI) rates in gynecologic procedures regularly in the past. Based on the Centers for Disease Control and Prevention's (CDC's) recommendations for preventing SSls the ICD instituted quality improvement activities looking specifically at antibiotic prophylaxis in gynecologic operative procedures. The CDC recommends that prophylactic antibiotics be administered within two hours prior to skin incision to be maximally effective. An initial 3-month study indicated that only 2.3% (1/44) of cases received prophylactic antibiotics within the a p p r o p r i a t e time because prophylactic antibiotics were being delivered "on-call" to the operating r o o m (OR). This "on-call" m e t h o d was unacceptable since the time the antibiotic was being given was unpredictable. Infection control collaborated with the gynecologic service, anesthesia department, nursing service and quality m a n a g e m e n t d e p a r t m e n t and devised a policy and procedure to deliver prophylactic antibiotics within two hours of surgical incision as r e c o m m e n d e d by the CDC. In the revised policy, rather than give the antibiotics "oncall to the OR," the patients were to receive the antibiotics in the OR proximal to the time of anticipated skin incision. The second 3-month study yielded an 82.4% (28/34) rate of patients receiving antibiotics within the appropriate time period. A third and fourth follow-up study revealed that 98.5% (64/65) and 100% (14/14) of patients respectively, received antibiotics within two hours of surgical incision. Thus, the gains in appropriate time-delivery of antibiotic prophylaxis was significantly improved and sustained. There was also a decrease in infection rates, from 4.08% in the first study and 5.5% in the second study to 0% in the third and fourth studies. Infection control practitioners should periodically review antibiotic prophylaxis protocols to ensure that the basic principles are being followed.
AN INVESTIGATION OF SURGICAL I N F E C T I O N S REVEALS A FLUID WARMER AS A RESERVOIR FOR BACTERIA. S. Burns, BS, CIC.* Henry Ford Hospital,
Detroit, MI. BACKGROUND: During a two-week period, four patients developed bloodstream infection within 2-10 days of a neurosurgical procedure. Preliminary investigation showed each patient with different gram-negative organisms and surgery performed on different days by various surgeons. METHODS: Investigation included: 1) case definition and chart review, 2) observations to identify breaks in aseptic technique, 3) environmental cultures from all opened multi-use vials and solutions in the neurosurgica] suites, and 4) hand cultures from neurosurgical nursing staff. FINDINGS: Chart review showed no common denominator. Observation of surgical procedures revealed no breaks in aseptic technique. A questionable break in clean technique was observed in the anesthesia workroom, where an anesthetic was being reconstituted on a workbench that was used for cleaning of c o n t a m i n a t e d instruments. Environmental cultures were negative, except water from the heated reservoirs of the Hofline ~ fluid warmers. The water contained >100,000 colonies of multiple gram negative organisms. None of these organisms matched the patients' organisms. However, it was noted that an open port allowed water to spill out and potentially contaminate gloved hand(s) during use. Hand cultures were negative. RECOMMENDATIONS: Reconstitution of the anesthetic was relocated to a laminar flow hood in the pharmacy. New guidelines were established for the maintenance and use of the Hofline ® fluid warmers. CONCLUSIONS: No common source for the infections was identified, however no new infections were noted in the next several months.
INCORPORATING SURGICAL PROPHYLACTIC ANTIBIOTIC MONITORING INTO ROUTINE N N I S SURVEILLANCE: A T H R E E Y E A R E X P E R I E N C E . A.
Adams, RN, MPH, CIC,* C. Francis, RN, MPH, CIC, B. Huvane, RN, MS, CIC, K. Mullaney, RN, MPH, CIC, B. Cuttle, MD. Montefiore Medical Center, Bronx, NY. In an effort to optimize surgical prophylaxis patterns at our 650-bed teaching hospital in a cost-effective manner, monitoring of prophylactic antibiotic usage was incorporated into the surgical surveillance component of the National Nosocomial Infection Surveillance (NNIS) system in 1995. Minor alterations in data collection forms provided a costeffective means of evaluating prophylactic use patterns which were effectively used to provide feedback to surgeons. Observed patterns of prophylaxis including selection of agent, timing, and duration were compared to institutional standards adopted from national guidelines. Patterns of improvement varied by surgical service. There was a 25.3%