Τομέας Υγείας - Μητέρας - ΠαιδιούLibrary of the School of Health Sciences
Βασιλική Σπούλου, Αναπλ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Γεώργιος Χρούσος, Καθηγητής, Ιατρική, ΕΚΠΑ
Θεοκλής Ζαούτης, Καθηγητής, Ιατρική, Πανεπιστήμιο Πενσυλβάνιας ΗΠΑ
Βασιλική Παπαευαγγέλου, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Susan Coffin, Καθηγήτρια, Ιατρική, Πανεπιστήμιο Πενσυλβάνιας ΗΠΑ
Νικόλαος Σπυρίδης, Επικ. Καθηγητής, Ιατρική, ΕΚΠΑ
Νοκόλαος Ζάβρας, Επικ. Καθηγητής, Ιατρική, ΕΚΠΑ
Η περιεγχειρητική αντιμικροβιακή προφύλαξη στα παιδιά: η συμμόρφωση με τις διεθνείς κατευθυντήριες οδηγίες και τα αποτελέσματα μιας εκπαιδευτικής παρέμβασης.
Perioperative antimicrobial prophylaxis in pediatric patients in Greece: compliance with guidelines and impact of an educational intervention.d
Introduction: Appropriate use of perioperative antimicrobial prophylaxis (AP) is essential to attain optimal pediatric patients’ outcomes as inappropriate timing and drug choice can raise the risk of Surgical Site Infections (SSIs). Inappropriately prolonged duration and overly broad spectrum of perioperative AP can raise risk of Clostridium difficile infection and contribute to development of multi-drug resistant organisms. Although guidelines for AP have been published, limited data are available regarding the degree of compliance with these guidelines in pediatric surgical populations. Determining adherence to these guidelines is particularly important in Greece, because the rate of antimicrobial consumption and prevalence of multi-drug resistant organisms are among the highest observed in developed nations.
Aim: The aims of this study were to assess the current perioperative AP practices in pediatric surgery patients in Greece, determine adherence to published guidelines and evaluate the effectiveness of an educational intervention to improve adherence to PAP guidelines in pediatric patients
Methods: A three-phase prospective study with a pre-post design was conducted from April 2013 until December 2014 in the Department of Pediatric Surgery of the Aghia Sophia Children’s Hospital, in Athens, Greece. Also, a one-year prospectivesurveillance study of pediatric surgical procedures was conducted from July 2014 to June 2015 to assess the timing of administration and the need for re-dosing of PAP in pediatric patients and determine adherence to published guidelines. All inpatients and outpatients subjected to one or more surgical procedures, as defined by the National Healthcare Surveillance Safety Network (NHSN) of Centers for Disease Control and Prevention (CDC), were eligible to be included in our study. A modified Centers for Disease Control’s (CDC) Denominator for Procedure form was used to collect clinical and PAP data. The educational intervention was targeted at all pediatric surgeons in the department. Outcomes assessed were the appropriateness of the agent selected for PAP (according to international guidelines) and appropriate termination of PAP within 24 hours of surgery completion. SSI rates were calculated before and after the intervention. Moreover, outcomes assessed were the timing of PAP’s administration (appropriate defined as within 60 minutes before surgery) and the need of intraoperative re-dosing of PAP (according to international guidelines), while SSI rates were also calculated.
Results: During the study period 889 children were enrolled (219 in the pre- and 670 in the post-intervention period). The percentage of patients receiving appropriate PAP improved from 6.2% to 77.1% after the educational intervention (p<0.001). The median duration of PAP was reduced from 5 to 1 days in pre- and post-intervention period, respectively. There was no increase in the rate of SSIs (0.93% and 0.92%, p=0.992, in pre- and post-intervention, respectively). Additionally, during the study period for assessing the timing and re-dosing of PAP, 483 children were enrolled. In the 60% of procedures antimicrobials were administered within 15 minutes before incision, while the timing of PAP was inappropriate in 11.4% of procedures. The SSI rate was 0.93% and 1.82% among patients with appropriate and inappropriate timing, respectively (p=0.542). Re-dosing was administered in the 40.9% of procedures, in which it was required.
Conclusions: An educational intervention targeted at pediatric surgeons improved the selection of agent and timely discontinuation of PAP. Moreover, the timing of preoperative dose of PAP was appropriate in the vast majority of cases, while further improvements are needed to ensure appropriate re-dosing
Main subject category:
Perioperative antimicrobial prophylaxis, Children, Intervention, Guidelines
Number of references: