Implementing a policy for pneumococcal prophylaxis in a haematology unit after splenectomy

Area of Science:

• Hematology
• Infectious Diseases
• Public Health

Background:

• Splenectomy significantly increases the risk of overwhelming post-splenectomy infection (OPSI), particularly pneumococcal infections and sepsis.
• Patients undergoing splenectomy are 40 times more likely to develop severe infections and 17 times more likely to experience fatal sepsis.
• Preventative measures, including pneumococcal vaccination and antibiotic prophylaxis, can reduce the incidence of these life-threatening infections.

Purpose of the Study:

• To audit the effectiveness of a formal policy for pneumococcal immunisation and antibiotic prophylaxis in patients undergoing elective splenectomy.
• To assess the impact of implementing a standardized care protocol on preventative measures for post-splenectomy infection risk.

Main Methods:

• Retrospective analysis of patient case notes.
• Audit conducted in July 1993, evaluating data from patients who had undergone splenectomy.
• Comparison of prophylaxis rates before and after the implementation of a formal policy in June 1988.

Main Results:

• Before the policy (June 1988), only 24% of splenectomy patients received both pneumococcal immunisation and antibiotic prophylaxis.
• After policy implementation, 62% received immunisation and 86% received antibiotic prophylaxis or a fever-activated antibiotic supply.
• All but one of the 20 patients who had splenectomies after the policy was enacted received appropriate prophylaxis.

Conclusions:

• Establishing a formal, agreed-upon policy for pneumococcal prophylaxis in splenectomy patients demonstrably improved the quality of care.
• Standardized protocols are effective in increasing the uptake of essential preventative measures for high-risk patient groups.
• The policy led to a significant increase in the provision of immunisation and antibiotic prophylaxis for patients undergoing splenectomy.