Adrian J Brink1,2, Angeliki P Messina3, Charles Feldman4, Guy A Richards4, Dena van den Bergh3. 1. Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa. 2. Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa. 3. Department of Quality Leadership, Netcare Hospitals Ltd, Johannesburg, South Africa. 4. Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
Background: Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. Objectives: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. Methods: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized. This 2.5 year intervention involved a pre-implementation phase to test a PAP guideline and a 'toolkit' at pilot sites. Following antimicrobial stewardship committee and clinician endorsement, the model was introduced in all institutions and a survey of baseline SSI and compliance rates with four process measures (antibiotic choice, dose, administration time and duration) was performed. The post-implementation phase involved audit, intervention and monthly feedback to facilitate improvements in compliance. Results: For 70 weeks of standardized measurements and feedback, 24 206 surgical cases were reviewed. There was a significant improvement in compliance with all process measures (composite compliance) from 66.8% (95% CI 64.8-68.7) to 83.3% (95% CI 80.8-85.8), representing a 24.7% increase ( P < 0.0001). The SSI rate decreased by 19.7% from a mean group rate of 2.46 (95% CI 2.18-2.73) pre-intervention to 1.97 post-intervention (95% CI 1.79-2.15) ( P = 0.0029). Conclusions: The implementation of process improvement initiatives and principles targeted to institutional needs utilizing pharmacists can effectively improve PAP guideline compliance and sustainable patient outcomes.
Background: Few data exist on the implementation of process measures to facilitate adherence to peri-operative antibiotic prophylaxis (PAP) guidelines in Africa. Objectives: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals. Methods: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized. This 2.5 year intervention involved a pre-implementation phase to test a PAP guideline and a 'toolkit' at pilot sites. Following antimicrobial stewardship committee and clinician endorsement, the model was introduced in all institutions and a survey of baseline SSI and compliance rates with four process measures (antibiotic choice, dose, administration time and duration) was performed. The post-implementation phase involved audit, intervention and monthly feedback to facilitate improvements in compliance. Results: For 70 weeks of standardized measurements and feedback, 24 206 surgical cases were reviewed. There was a significant improvement in compliance with all process measures (composite compliance) from 66.8% (95% CI 64.8-68.7) to 83.3% (95% CI 80.8-85.8), representing a 24.7% increase ( P < 0.0001). The SSI rate decreased by 19.7% from a mean group rate of 2.46 (95% CI 2.18-2.73) pre-intervention to 1.97 post-intervention (95% CI 1.79-2.15) ( P = 0.0029). Conclusions: The implementation of process improvement initiatives and principles targeted to institutional needs utilizing pharmacists can effectively improve PAP guideline compliance and sustainable patient outcomes.
Authors: Matteo Bassetti; Garyphallia Poulakou; Etienne Ruppe; Emilio Bouza; Sebastian J Van Hal; Adrian Brink Journal: Intensive Care Med Date: 2017-07-21 Impact factor: 17.440
Authors: Massimo Sartelli; Francesco M Labricciosa; Pamela Barbadoro; Leonardo Pagani; Luca Ansaloni; Adrian J Brink; Jean Carlet; Ashish Khanna; Alain Chichom-Mefire; Federico Coccolini; Salomone Di Saverio; Addison K May; Pierluigi Viale; Richard R Watkins; Luigia Scudeller; Lilian M Abbo; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Sara Al-Dahir; Majdi N Al-Hasan; Halil Alis; Carlos Alves; André R Araujo da Silva; Goran Augustin; Miklosh Bala; Philip S Barie; Marcelo A Beltrán; Aneel Bhangu; Belefquih Bouchra; Stephen M Brecher; Miguel A Caínzos; Adrian Camacho-Ortiz; Marco Catani; Sujith J Chandy; Asri Che Jusoh; Jill R Cherry-Bukowiec; Osvaldo Chiara; Elif Colak; Oliver A Cornely; Yunfeng Cui; Zaza Demetrashvili; Belinda De Simone; Jan J De Waele; Sameer Dhingra; Francesco Di Marzo; Agron Dogjani; Gereltuya Dorj; Laurent Dortet; Therese M Duane; Mutasim M Elmangory; Mushira A Enani; Paula Ferrada; J Esteban Foianini; Mahir Gachabayov; Chinmay Gandhi; Wagih Mommtaz Ghnnam; Helen Giamarellou; Georgios Gkiokas; Harumi Gomi; Tatjana Goranovic; Ewen A Griffiths; Rosio I Guerra Gronerth; Julio C Haidamus Monteiro; Timothy C Hardcastle; Andreas Hecker; Adrien M Hodonou; Orestis Ioannidis; Arda Isik; Katia A Iskandar; Hossein S Kafil; Souha S Kanj; Lewis J Kaplan; Garima Kapoor; Aleksandar R Karamarkovic; Jakub Kenig; Ivan Kerschaever; Faryal Khamis; Vladimir Khokha; Ronald Kiguba; Hong B Kim; Wen-Chien Ko; Kaoru Koike; Iryna Kozlovska; Anand Kumar; Leonel Lagunes; Rifat Latifi; Jae G Lee; Young R Lee; Ari Leppäniemi; Yousheng Li; Stephen Y Liang; Warren Lowman; Gustavo M Machain; Marc Maegele; Piotr Major; Sydney Malama; Ramiro Manzano-Nunez; Athanasios Marinis; Isidro Martinez Casas; Sanjay Marwah; Emilio Maseda; Michael E McFarlane; Ziad Memish; Dominik Mertz; Cristian Mesina; Shyam K Mishra; Ernest E Moore; Akutu Munyika; Eleftherios Mylonakis; Lena Napolitano; Ionut Negoi; Milica D Nestorovic; David P Nicolau; Abdelkarim H Omari; Carlos A Ordonez; José-Artur Paiva; Narayan D Pant; Jose G Parreira; Michal Pędziwiatr; Bruno M Pereira; Alfredo Ponce-de-Leon; Garyphallia Poulakou; Jacobus Preller; Céline Pulcini; Guntars Pupelis; Martha Quiodettis; Timothy M Rawson; Tarcisio Reis; Miran Rems; Sandro Rizoli; Jason Roberts; Nuno Rocha Pereira; Jesús Rodríguez-Baño; Boris Sakakushev; James Sanders; Natalia Santos; Norio Sato; Robert G Sawyer; Sandro Scarpelini; Loredana Scoccia; Nusrat Shafiq; Vishalkumar Shelat; Costi D Sifri; Boonying Siribumrungwong; Kjetil Søreide; Rodolfo Soto; Hamilton P de Souza; Peep Talving; Ngo Tat Trung; Jeffrey M Tessier; Mario Tumbarello; Jan Ulrych; Selman Uranues; Harry Van Goor; Andras Vereczkei; Florian Wagenlehner; Yonghong Xiao; Kuo-Ching Yuan; Agnes Wechsler-Fördös; Jean-Ralph Zahar; Tanya L Zakrison; Brian Zuckerbraun; Wietse P Zuidema; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-01 Impact factor: 5.469
Authors: Jeffrey W Hall; Jeannette Bouchard; P Brandon Bookstaver; Matthew S Haldeman; Peter Kishimbo; Godlove Mbwanji; Issakwisa Mwakyula; Davance Mwasomola; Megan Seddon; Mark Shaffer; Stephanie C Shealy; Anthony Nsojo Journal: Pharmacy (Basel) Date: 2020-06-24
Authors: Lesley Cooper; Jacqueline Sneddon; Daniel Kwame Afriyie; Israel A Sefah; Amanj Kurdi; Brian Godman; R Andrew Seaton Journal: JAC Antimicrob Resist Date: 2020-10-05