1046. Compliance of Antibiotic Intraoperative REdosing: The CARE Study
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: The Surgical Care Improvement Project (SCIP) has established antimicrobial surgical prophylaxis guidelines to reduce surgical site infections (SSI). Intraoperative re-dosing is needed to ensure adequate serum and tissue concentrations of the antimicrobial if the duration of the procedure exceeds two t-½ of the antimicrobial or there is excessive blood loss (>1500 mL).

Methods: This was a retrospective cohort study (March 2009-October 2012) to assess compliance of appropriate intraoperative antimicrobial surgical prophylaxis re-dosing (ASPR) at Jackson Memorial Hospital (Miami, FL) over 3 epochs. Compliance was determined for each time interval: baseline (March 2009-March 2010); followed by staff training, implementation of a standardized protocol and an automated intraoperative paging system with direct feedback to attending anesthesiologists (April 2010-April 2012).  Auto-paging was triggered based on the previous dosing time as recorded in our electronic anesthesia record. Fifteen minutes before the ASPR was due, a text page was sent to the anesthesia attending supervising the case. The third period included only automated pager reminders (May 2012-October 2012) without feedback.

Results: ASPR in 7,461 (out of 75,230) surgeries was analyzed. Patients’ mean age was 45 ± 19 years old and 62.6% were female. Most common procedures that required ASPR were neurosurgical and orthopedic. Most commonly used antimicrobials were cefazolin and cefoxitin. Flouroquinolones and ampicillin-sulbactam had the highest rates of compliance throughout each period. Baseline compliance (N=2,183) was 15.8%; significantly improved to 65.3% with paging and direct feedback (N=4,486; p< 0.001). The compliance rate improved further to 76.7% when only a reminder was given without feedback (p< 0.001 compared to no reminder); compliance rates did not significantly differ between the pager and feedback compared to the pager alone.

Conclusion: Automated intraoperative paging reminders coupled with provider education and an ASP protocol can increase compliance with appropriate intraoperative ASP re-dosing during prolonged procedures. Appropriate use of antimicrobials in surgical prophylaxis should be an important component of antimicrobial stewardship activities.

Gina Riggi, PharmD1, Mayela Castillo, PharmD, BCPS1, Margaret Fernandez, PharmD, BCPS1, Andrew Wawrzyniak, PhD2, Michael Vigoda, MD3 and Lilian Abbo, MD4, (1)Jackson Memorial Hospital, Miami, FL, (2)School of Nursing & Health Studies and Departments of Miami School of Medicine University of Miami, Miami, FL, (3)Department of Anesthesia, Miller School of Medicine, University of Miami, Miami, FL, (4)Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL


G. Riggi, None

M. Castillo, None

M. Fernandez, None

A. Wawrzyniak, None

M. Vigoda, None

L. Abbo, None

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