1. 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

2. 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.

3. 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

4. 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

5. 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

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

7. Antibiotics given within 60 minutes prior to incision have improved
110
UCL =
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

8. 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

9. Discontinuation of antibiotics within 24 hours has improved

10. 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