Marta Ciofi Degli Atti1, Stefania Spila Alegiani2, Roberto Raschetti2, Pasquale Arace3, Angela Giusti2, Raffaele Spiazzi4, Massimiliano Raponi5. 1. Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy. marta.ciofidegliatti@opbg.net. 2. National Centre for Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy. 3. Medical Direction, Ospedale Santobono Pausilipon, Via Della Croce Rossa 8, 80122, Naples, Italy. 4. Medical Direction, Ospedale dei Bambini di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy. 5. Medical Direction, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
Abstract
PURPOSE: The use of surgical antibiotic prophylaxis (SAP) in children is poorly characterized. Our aim was to evaluate the effectiveness of a quality improvement (QI) intervention targeting SAP in children, by means of a multicenter prospective intervention study, with a before and after design. METHODS: We prospectively investigated elective surgical procedures performed in children <18 years, prior to the QI intervention, after the intervention and at 9-month follow-up. The primary outcomes were adherence to SAP indications and SAP appropriateness, defined considering antibiotic choice, timing of first dose and duration of administration. We compared SAP adherence and appropriateness prior the QI intervention, to the post-intervention and the follow-up. We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness. RESULTS: We collected information on 2383 procedures (pre-intervention: 784; post-intervention: 790; follow-up: 809). The QI intervention had a significant impact on the adherence to SAP indications (86.6% in the post-intervention, compared to 82.0% prior to the intervention; p < 0.05), and on its appropriateness (35.7% compared to 19.9%; p < 0.01). The impact of the intervention on SAP appropriateness was maintained at follow-up (38.3%; p < 0.01 compared to pre-intervention). All components of SAP appropriateness significantly improved after the intervention and at follow-up. The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness. CONCLUSIONS: Following the QI intervention, there was a significant improvement in quality of SAP in pediatric surgery, though more efforts are needed to increase SAP appropriateness.
RCT Entities:
PURPOSE: The use of surgical antibiotic prophylaxis (SAP) in children is poorly characterized. Our aim was to evaluate the effectiveness of a quality improvement (QI) intervention targeting SAP in children, by means of a multicenter prospective intervention study, with a before and after design. METHODS: We prospectively investigated elective surgical procedures performed in children <18 years, prior to the QI intervention, after the intervention and at 9-month follow-up. The primary outcomes were adherence to SAP indications and SAP appropriateness, defined considering antibiotic choice, timing of first dose and duration of administration. We compared SAP adherence and appropriateness prior the QI intervention, to the post-intervention and the follow-up. We considered patient and procedure characteristics as covariates in two logistic regression models to assess the effect of the QI intervention on SAP adherence and appropriateness. RESULTS: We collected information on 2383 procedures (pre-intervention: 784; post-intervention: 790; follow-up: 809). The QI intervention had a significant impact on the adherence to SAP indications (86.6% in the post-intervention, compared to 82.0% prior to the intervention; p < 0.05), and on its appropriateness (35.7% compared to 19.9%; p < 0.01). The impact of the intervention on SAP appropriateness was maintained at follow-up (38.3%; p < 0.01 compared to pre-intervention). All components of SAP appropriateness significantly improved after the intervention and at follow-up. The logistic regression analyses confirmed the effect of intervention in improving adherence to SAP indications and appropriateness. CONCLUSIONS: Following the QI intervention, there was a significant improvement in quality of SAP in pediatric surgery, though more efforts are needed to increase SAP appropriateness.
Authors: Russell B Hawkins; Shauna M Levy; Casey E Senter; Jane Y Zhao; Kaitlin Doody; Lillian S Kao; Kevin P Lally; KuoJen Tsao Journal: Am J Surg Date: 2013-06-27 Impact factor: 2.565
Authors: Shauna M Levy; Uma R Phatak; Kuojen Tsao; Curtis J Wray; Stefanos G Millas; Kevin P Lally; Lillian S Kao Journal: J Am Coll Surg Date: 2013-09-13 Impact factor: 6.113
Authors: D Donà; E Barbieri; M Daverio; R Lundin; C Giaquinto; T Zaoutis; M Sharland Journal: Antimicrob Resist Infect Control Date: 2020-01-03 Impact factor: 4.887