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Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room

Zanetti, Giorgio ; Flanagan, Hugh L. ; Cohn, Lawrence H. ; Giardina, Richard ; Platt, Richard

In: Infection Control & Hospital Epidemiology, 2003, vol. 24, no. 1, p. 13-16

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    Titre
    • Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room
    Auteur
    • Zanetti, Giorgio. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
    • Flanagan, Hugh L.. Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    • Cohn, Lawrence H.. Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
    • Giardina, Richard. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
    • Platt, Richard. Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Infection Control & Hospital Epidemiology, 2003, vol. 24, no. 1, p. 13-16. Cambridge University Press
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:290796
    Summary
    Abstract Objective: To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations. Design: Randomized, controlled, evaluator-blinded trial. Setting: University-affiliated hospital. Patients: Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery. Intervention: Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered. Results: Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02). Conclusion: The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis