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Electronic surveillance system for monitoring surgical antimicrobial prophylaxis
Sara Bornstein Voit1, James K Todd, Bernard Nelson
1Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Objectives:
Antimicrobial surgical prophylaxis comprises one third of all antibiotic use in pediatric hospitals and 80% of all antibiotic use in surgery. Previous studies reported that antimicrobial surgical prophylaxis is often inconsistent with recommended guidelines. An electronic surveillance system was developed to measure antimicrobial utilization and to identify opportunities to improve and monitor the administration of antibiotics for surgical prophylaxis.
Methods:
A retrospective cohort study was conducted on patients with selected inpatient surgical procedures performed from May 1999 to April 2000 at 4 US children's hospitals. International Classification of Diseases, Ninth Revision surgical procedure codes were divided into clean or unclean categories, and an electronic surveillance system was designed using antibiotic and microbiologic culture utilization data to measure appropriate antimicrobial use associated with the surgical procedure. A medical chart review was conducted to validate the electronic system.
Results:
Ninety percent of cases were classified properly by the electronic surveillance system as confirmed by medical chart review. Surgical antibiotic prophylaxis was not in accordance with the American Academy of Pediatrics (AAP) guidelines for almost half of all procedures. Prolonged antimicrobial administration in clean surgical procedures was the most frequent deviation from guidelines. Statistical differences between the index hospital and the comparison hospitals reflect both over- and underutilization of surgical prophylaxis with significant opportunity to improve prophylaxis for all hospitals.
Conclusions:
Antimicrobial surgical prophylaxis at the children's hospitals studied is not always consistent with published AAP guidelines. This electronic surveillance system provides a rapid, reproducible, and validated tool to measure easily the efforts to improve adherence to AAP surgical prophylaxis guidelines.
Insights
Surgical antibiotic prophylaxis in children's hospitals often deviates from American Academy of Pediatrics guidelines. An electronic surveillance system helps monitor and improve antimicrobial use for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Health Informatics
Background:
- Antimicrobial surgical prophylaxis is a significant contributor to antibiotic use in pediatric hospitals.
- Existing practices for surgical prophylaxis frequently do not align with established clinical guidelines.
- There is a need for effective methods to monitor and enhance the appropriate administration of antibiotics in surgical settings.
Purpose of the Study:
- To develop and evaluate an electronic surveillance system for measuring antimicrobial utilization in surgical prophylaxis.
- To identify specific areas for improvement in the adherence to antimicrobial surgical prophylaxis guidelines.
- To monitor the impact of interventions aimed at optimizing antibiotic use in pediatric surgical procedures.
Main Methods:
- A retrospective cohort study involving pediatric surgical patients across four US children's hospitals.
- Development of an electronic surveillance system utilizing International Classification of Diseases, Ninth Revision codes and antibiotic/microbiologic data.
- Validation of the electronic system through a comprehensive medical chart review process.
Main Results:
- The electronic surveillance system demonstrated high accuracy (90%) in classifying cases.
- Nearly half of all surgical procedures exhibited antimicrobial prophylaxis that was inconsistent with American Academy of Pediatrics guidelines.
- Prolonged antibiotic use in clean surgical procedures was the most common guideline deviation, indicating significant opportunities for improvement.
Conclusions:
- Antimicrobial surgical prophylaxis in the studied pediatric hospitals frequently deviates from American Academy of Pediatrics guidelines.
- The developed electronic surveillance system offers a validated, efficient, and reproducible method for assessing adherence to prophylaxis guidelines.
- This system can effectively support efforts to improve antimicrobial stewardship in pediatric surgical care.
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