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The impact of a multimodel approach to designing a new orthopedic department

Published online by Cambridge University Press:  11 December 2020

Elad Keren
Affiliation:
Orthopedic Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Abraham Borer
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lior Nesher
Affiliation:
Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tali Shafat
Affiliation:
Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Rivka Yosipovich
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
Ronit Nativ
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
Orly Shimoni
Affiliation:
Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orli Sagi
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lilia Greenshpoon
Affiliation:
Orthopedic Department, Soroka University Medical Center, Beer-Sheva, Israel
Lisa Saidel-Odes*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Author for correspondence: Dr Lisa Saidel-Odes, E-mail: lisasod@clalit.org.il

Abstract

Objective:

To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department.

Design:

Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention.

Setting:

A 1,000-bed, tertiary-care, university hospital.

Patients:

Adult patients admitted to the orthopedics department between January 2015 and December 2018.

Methods:

During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed.

Results:

The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001).

Conclusions:

Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

Type
Original Article
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

PREVIOUS PRESENTATION: This work was presented in part as an oral presentation (no. 1303) at the APIC 2019 Annual Conference on June 13, 2019, in Philadelphia, Pennsylvania.

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