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Ranji SR, Shetty K, Posley KA, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jan. (Technical Reviews, No. 9.6.)
Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections).
Show detailsTable 4eArticles addressing prevention of surgical site infections (studies addressing use of appropriate antibiotic prophylaxis): before-after studies with poor methodologic quality
| Author | Setting and Hospital Type | Study period | Length of follow-up | Preventive Interventions | Quality improvement intervention | Results |
|---|---|---|---|---|---|---|
| Brusaferro 200175 | Italy | 12/1998 | 6 months | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, audit and feedback | Compliance to guideline for perioperative antibiotic prescribing: |
| Tertiary care or university hospital | A protocol for perioperative antibiotic prophylaxis was developed by a group consisting of a microbiologist, chemist, anesthetist, clinical pharmacologist and three surgeons. Compliance with the protocol was measured before and after the intervention. Follow-up focus groups were conducted with the group and the surgical units after the data were collected. | before intervention: 4.3% | ||||
| after intervention: 17.4% | ||||||
| p<0.01 | ||||||
| Smith 198877 | United States | 5/1988 – 11/1988 | 16 months | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, clinician reminder | Compliance with using single dose cefazolin as preoperative antibiotic prophylaxis, percent compliance before intervention: 0% |
| Tertiary care or university hospital |
| after intervention: 42.8% | ||||
| p value not supplied | ||||||
| St. Jacques 200578 | United States | Not specified | 1 month | Appropriate use of perioperative antibiotics | QI Strategies: Clinician reminder | Adherence to appropriate timing of perioperative antibiotics: |
| Tertiary care or university hospital | Used computer reminder system to assist in intraoperative redosing of prophylactic antibiotics. | before intervention: 20% | ||||
| after intervention: 57% | ||||||
| p<0.01 | ||||||
| Talon 200173 | France | 6/1998–7/1998 | 2 months | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, audit and feedback | Adherence to appropriate timing of perioperative antibiotics: |
| Hospital type not specified | Audit and feedback of infection rates to hospitals or individual clinicians | A survey of antibiotic prescribing practices was performed and used to develop local guidelines for antimicrobial prophylaxis by a multidisciplinary team. | before intervention: 89% | |||
| Diffusion of guidelines to all surgeons and anesthetists, as well as display of guidelines. | after intervention: 98% | |||||
| Adherence to administering perioperative antibiotics for the appropriate duration: | ||||||
| before intervention: 76% | ||||||
| after intervention: 94% | ||||||
| Adherence to appropriate selection of perioperative antibiotics: | ||||||
| before intervention: 74% | ||||||
| after intervention: 96% | ||||||
| Overall percentage of inappropriate prescriptions (timing, duration, and selection): | ||||||
| Before intervention: 69% | ||||||
| After intervention: 18%; p=0.01 | ||||||
| Prado 200283 | Brazil | 10/1999 | 1 month | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, clinician reminder | Infection rate prior to intervention: 4.1% |
| Tertiary care or university hospital | Multiple interventions were instituted: | Infection rate after intervention: 4.2%; p=NS | ||||
| Adherence to administering perioperative antibiotics for the appropriate duration: | |||||
| before intervention: 21.4% | ||||||
| after intervention: 95.8%; p<0.01 | ||||||
| Adherence to appropriate selection of perioperative antibiotics: | ||||||
| before intervention: 74.5% | ||||||
| after intervention: 97.2%; p<0.01 | ||||||
| Gyssens 199680 | Netherlands | 1990 -1992 | 14 months | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, clinician reminder | Adherence to administering perioperative antibiotics for the appropriate duration: |
| Tertiary care or university hospital | A guideline for standard surgical antimicrobial prophylaxis was introduced, which called for standard single-dose prophylaxis with a cephalosporin to be delivered within 1 hour prior to surgical incision. | before intervention: 21% | ||||
| The guideline was introduced after a preintervention period in which the rates of appropriate antimicrobial prophylaxis were measured and reported to the department chairpersons. The protocol was developed in concert with the surgeons. The guideline was presented to the surgical department and junior pharmacists introduced it to the nursing staff (no other details on the implementation process are provided.) | after intervention: 85% | |||||
| p<0.01 | ||||||
| Adherence to appropriate timing of perioperative antibiotics: | ||||||
| before intervention: 42% | ||||||
| after intervention: 73% | ||||||
| p<0.01 | ||||||
| Gyssens 199684 | Netherlands | 1 month | Not specified | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education, audit and feedback, clinician reminder | Adherence to administering perioperative antibiotics for the appropriate duration: |
| Tertiary care or university hospital | The principal goal was to universally have a single-dose of cephazolin at incision. | before intervention: 79% | ||||
| Recommendations were adapted into new protocols and presentations were held on these new protocols. Junior pharmacists organized briefings for nurses and prophylaxis guidelines were displayed in the wards and operating rooms. Pharmacy techs discussed protocol violations with prescribers and nurses on their twice weekly visits to wards. | after intervention: 92% | |||||
| p<0.01 | ||||||
| Shapiro 198165 | Israel | Not specified | Not specified | Appropriate use of perioperative antibiotics | QI Strategies: Clinician education | Adherence to administering perioperative antibiotics for the appropriate duration: |
| Multiple hospitals of different types | Introduction of a protocol involving changing the perioperative antibiotics used previously, initiating prophylaxis shortly before the operation, and encouraged the curtailment of prophylactic administration of antimicrobial drugs in the early postoperative period. | before intervention: 39% | ||||
| after intervention: 97% p value not supplied | ||||||
| p value not supplied | ||||||
- Table 4e, Articles addressing prevention of surgical site infections (studies ad...Table 4e, Articles addressing prevention of surgical site infections (studies addressing use of appropriate antibiotic prophylaxis): before-after studies with poor methodologic quality - Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections)
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