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Identifying targets for improvement using a nationally standardized survey: Surgical antimicrobial prophylaxis in orthopedic surgery

Published online by Cambridge University Press:  25 August 2020

Courtney E. Ierano Open the ORCID record for Courtney E. Ierano [Opens in a new window] ,
Karin Thursky Open the ORCID record for Karin Thursky [Opens in a new window] ,
Caroline Marshall Open the ORCID record for Caroline Marshall [Opens in a new window] ,
Sonia Koning ,
Rodney James ,
Sandra Johnson ,
Nabeel Imam ,
Leon J. Worth Open the ORCID record for Leon J. Worth [Opens in a new window]  and
Trisha Peel Open the ORCID record for Trisha Peel [Opens in a new window]
Courtney E. Ierano*
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
Karin Thursky
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Caroline Marshall
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia Victorian Infectious Diseases Service (VIDS), Royal Melbourne Hospital, Parkville, Victoria, Australia Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
Sonia Koning
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia
Rodney James
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia
Sandra Johnson
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne, Victoria, Australia
Nabeel Imam
Affiliation:
Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne, Victoria, Australia
Leon J. Worth
Affiliation:
University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne, Victoria, Australia National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
Trisha Peel
Affiliation:
National Health and Medical Research Council Centre of Research Excellence: National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity Melbourne, Melbourne, Victoria, Australia Department of Infectious Diseases, Alfred Health/Monash University, Melbourne, Victoria, Australia
*
Author for correspondence: Courtney E. Ierano, E-mail: cierano@student.unimelb.edu.au
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Abstract

Background:

Surgical antimicrobial prophylaxis (SAP) is commonly administered in orthopedic procedures. Research regarding SAP appropriateness for specific orthopedic procedures is limited and is required to facilitate targeted orthopedic prescriber behavior change.

Objectives:

To describe SAP prescribing and appropriateness for orthopedic procedures in Australian hospitals.

Design, setting, and participants:

Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) audits from January 1, 2016, to April 15, 2019, were analyzed.

Methods:

Logistic regression identified hospital, patient and surgical factors associated with appropriateness. Adjusted appropriateness was calculated from the multivariable model. Additional subanalyses were conducted on smaller subsets to calculate the adjusted appropriateness for specific orthopedic procedures.

Results:

In total, 140 facilities contributed to orthopedic audits in the Surgical NAPS, including 4,032 orthopedic surgical episodes and 6,709 prescribed doses. Overall appropriateness was low, 58.0% (n = 3,894). This differed for prescribed procedural (n = 3,978, 64.7%) and postprocedural doses (n = 2,731, 48.3%). The most common reasons for inappropriateness, when prophylaxis was required, was timing for procedural doses (50.9%) and duration for postprocedural prescriptions (49.8%). The adjusted appropriateness of each orthopedic procedure group was low for procedural SAP (knee surgery, 54.1% to total knee joint replacement, 74.1%). The adjusted appropriateness for postprocedural prescription was also low (from hand surgery, 40.7%, to closed reduction fractures, 68.7%).

Conclusions:

Orthopedic surgical specialties demonstrated differences across procedural and postprocedural appropriateness. The metric of appropriateness identifies targets for quality improvement and is meaningful for clinicians. Targeted quality improvement projects for orthopedic specialties need to be developed to support optimization of antimicrobial use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 12 , December 2020 , pp. 1419 - 1428
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: An abstract of this manuscript was accepted as an oral presentation for the Society for Healthcare Epidemiology of America (SHEA) 6th Decennial International Conference on Healthcare Associated Infections. However, this conference was cancelled due to the current COVID19 pandemic. The abstract is pending publication in an ICHE supplement.

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