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Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments

Published online by Cambridge University Press:  17 November 2020

Elisavet Chorafa ,
Elias Iosifidis ,
Sotirios Tsiodras ,
Athanasios Skoutelis ,
Eleni Kourkouni ,
Ioannis Kopsidas ,
Grammatiki-Christina Tsopela ,
Evangelia Chorianopoulou ,
Christos Triantafyllou  and
Georgia Kourlaba
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Elisavet Chorafa
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
Elias Iosifidis
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
Sotirios Tsiodras
Affiliation:
Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
Athanasios Skoutelis
Affiliation:
Fifth Department of Medicine and Infectious Diseases Unit, Evangelismos General Hospital, Athens, Greece
Eleni Kourkouni
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Ioannis Kopsidas
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Grammatiki-Christina Tsopela
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Evangelia Chorianopoulou
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Christos Triantafyllou
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Georgia Kourlaba
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Theoklis Zaoutis
Affiliation:
Center for Clinical Epidemiology and Outcomes Research (CLEO), Nonprofit Civil Partnership, Athens, Greece
Emmanuel Roilides*
Affiliation:
Infectious Diseases Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
*
Author for correspondence: Emmanuel Roilides, E-mail: roilides@med.auth.gr
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Abstract

Objective:

To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP).

Design:

Prospective multicenter before-and-after study.

Setting:

This study was conducted in 7 surgical departments of 3 major Greek hospitals.

Methods:

Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback.

Results:

Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP.

Conclusion:

An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 6 , June 2021 , pp. 702 - 709
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PHiG investigators: Polyxeni Karakosta MD, PhD, Sofia Kostourou RN, MSc, PhD, Sofia Kouni MSc, PhD, Christina Logotheti RN, MSc, Stefania Maistreli MSc, Nafsika-Maria Molocha MSc, Eleni Mylona MD, PhD and Fani Veini, RN, MSc, PhD.

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