Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room.

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.

authors

Zanetti G,Flanagan HL Jr,Cohn LH,Giardina R,Platt R

doi

10.1086/502109

subject

Has Abstract

pub_date

2003-01-01 00:00:00

pages

13-6

issue

1

eissn

0899-823X

issn

1559-6834

pii

ICHE4790

journal_volume

24

pub_type

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