Preventing Surgical Infections Through Effective Perioperative Antibiotic Administration Project Team: Anesthesia Infectious Disease Pharmacy Surgical Services Center for Clinical Effectiveness Loyola University Chicago LOYOLA UNIVERSITY HEALTH SYSTEM

Opportunity Statement Surgical site infections are a major complication after surgery resulting in considerable morbidity, mortality, and resource utilization. Proper use of antibiotics – giving the right drug at the right time – is effective in preventing infections after surgery.

Project Goals To achieve 100% compliance for targeted surgeries for the following measures: Administer antibiotics within one hour before surgical incision Administer the appropriate antibiotic Stop antibiotics within 24 hours after surgery

Most Likely Causes Accountability for process not clearly defined (surgeon, anesthesia, nurse) Variation in physician ordering practices Antibiotic not administered within recommended time intervals Variability in documentation of antibiotic administration

Solutions Implemented Developed and implemented guidelines and supporting documentation tools Surgical anti-microbial prophylaxis guidelines on the EMR Unrestricting of vancomycin for penicillin allergic patients Standardized documentation Education for attendings, residents, CRNA’s, and nurses

Targeted Surgeries - per CMS & CDC guidelines Abdominal and Vaginal Hysterectomy Hip and Knee Replacement Cardiac Bypass Other Cardiac surgery Vascular surgery Colon surgery

Antibiotics given within 60 minutes prior to incision have improved 110 UCL = 107.24 Project Started 100 Mean = 88.1 90 80 Percent of Patients 70 LCL = 68.94 60 50 Nov 01 Feb 02 Apr 02 May 02 Jul 02 Sep 02 Nov 02 Jun 03 Sep 03 Jan 04 Baseline 00

Use of the appropriate antibiotic has improved significantly 100% 97% 98% 90% 86% 80% Percent of Patients 70% 58% 60% 50% Nov-02 Jun-03 Sep-03 Jan 04 Chart Review Time

Discontinuation of antibiotics within 24 hours has improved

Next Steps Share department specific results and explore opportunities to achieve 100% compliance with each measure Review and revise order sets as needed Plan for public reporting of data