A. H. Sohail1, J. Mendelson1, R. De La O1, T. B. Pacheco1, M. Oberoi1, M. S. Khan1, J. Maurer1,2 1NYU Langone Health, Mineola, NY, USA 2Mount Sinai South Nassau, General Surgery, Oceanside, NY, USA 3University Of Texas Health Science Center At Houston, Houston, TX, USA
Introduction:
Perioperative antimicrobial prophylaxis is a well-established evidence-based intervention to prevent surgical site infections (SSI) by reducing the microorganism burden at the surgical site. The national guidelines of prophylaxis for appendectomy for uncomplicated appendicitis (for patients >18 years) state that cefoxitin, cefotetan, or the combination of cefazolin and metronidazole should be administered to the non-penicillin-allergic patient within a sixty-minute window preceding the first surgical incision. Patients with severe penicillin allergies should receive aztreonam, a fluoroquinolone, or the combination of clindamycin and an aminoglycoside within the same timeframe. The goal of this project was to investigate the effect of educational intervention on adherence to these national guidelines from at our tertiary care center in New York.
Methods:
The first intervention implemented was extensive education of both faculty and residents. This occurred at both the Department of Surgery’s Weekly Morbidity and Mortality Conference and the Department of Anesthesiology’s Monthly Quality Improvment Meeting (Dates of intervention were November 29 and December 13). At these conferences, presentations included background information about the national guidelines, preliminary data showing an institutional lack of adherence, and further plans to effect significant and sustained change. Both of these presentations ended with an extensive Question and Answer session about both the national guidelines and this specific project.
Results:
In the pre-intervention period (fourteen month period prior to intervention), adherence to these national guidelines at New York University Langone Hospital–Long Island was just 20.35% overall (69/339 patients). Of these 339 patients were >18 years who underwent appendectomy for uncomplicated appendicitis throughout this period, 191 (56.34%) received prophylaxis within the proper timeframe, but just 74 (21.83%) received the proper antimicrobial prophylaxis. 69 patients received the proper antimicrobial prophylaxis within the proper timeframe.
In the post-intervention period (two months post intervention), adherence to the national guidelines was 24.32% overall (9/37 patients). Of these 37 patients who underwent appendectomy for uncomplicated appendicitis, 23 (62.16%) received prophylaxis within the proper timeframe, but just 10 (27.03%) received the proper antimicrobial prophylaxis. Of note, overall adherence was significantly improved in January (36.36%; month immediately after intervention) compared to December (6.67%).
Conclusion:
Extensive education alone can be an effective short-term strategy to improve adherence to national guidelines regarding procedure-specific antimicrobial prophylaxis. Overall adherence to national guidelines for appendectomy prophylaxis improved from 20.35% in the pre-intervention period to 24.32% in the post-intervention period.