Clinical Practice Audit: Perioperative Antibiotic Prophylaxis in Paediatric Cancer Patients with Broviac Catheter
1Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany.
Insights
This audit of perioperative antimicrobial prophylaxis (PAP) in paediatric oncology patients found issues with antibiotic dosing and choice. Improvements were seen in the prospective group, highlighting challenges in optimizing clinical workflows.
Area of Science:
- Medical Microbiology
- Clinical Pharmacy
- Paediatric Oncology
Background:
- Perioperative antimicrobial prophylaxis (PAP) is crucial for preventing surgical site infections (SSI) in patients undergoing procedures.
- Paediatric oncology patients with central venous catheters (CVAD) have a higher risk of SSI.
- Internal audits are essential for ensuring judicious antibiotic use in healthcare settings.
Purpose of the Study:
- To conduct a comprehensive audit of PAP practices in a German paediatric oncology centre.
- To evaluate adherence to internal PAP guidelines for CVAD implantations.
- To identify areas for improvement in antibiotic selection, dosing, and duration.
Main Methods:
- A systematic audit of 97 CVAD implantations in 89 paediatric oncology patients was performed.
- Data was collected retrospectively (2012-2014) and prospectively (2014-2015) after guideline implementation.
- Surgical site infections (SSI) were monitored for up to 30 days post-operation.
Main Results:
- Lower-than-recommended doses of Cefuroxim were frequently observed.
- Inappropriate antibiotic choices (Cefotaxim, Clindamycin) occurred in a small number of cases.
- PAP duration significantly improved from 22% to 91% adherence to ≤24 hours in the prospective group (p<0.001).
- No surgical site infections (SSI) were detected in any patient.
Conclusions:
- Significant opportunities exist to improve PAP practices in paediatric oncology settings, focusing on correct antibiotic dosing and selection.
- The study highlights the challenges in optimizing standard clinical workflows for antibiotic prophylaxis.
- Despite identified areas for improvement, no SSIs were observed, suggesting the current PAP protocols may still be effective.
Background:
Perioperative antimicrobial prophylaxis (PAP) is an important target for internal audits, concerning the judicious use of antibiotics. Paediatric oncology patients face an increased risk of surgical site infection (SSI) after implantation of long term central venous catheters (CVAD).
Patients:
All PATIENTS<18 years admitted to the paediatric oncology centre (POC) with implantation of a CVAD.
Methods:
Systematic audit in 2 groups: retrospective (Jan 01, 2012 - March 31, 2014) and prospective (April 01, 2014 - March 31, 2015) referring to an internal PAP guideline, invented in Jan 2014. Surveillance of SSI up to 30 days after the operation.
Results:
In total, 97 CVAD implantations were analysed in 89 paediatric oncology patients (Broviac in 94%). The detailed analysis of PAP revealed lower Cefuroxim doses than requested (30 vs. 50 mg/kg). In addition, Cefotaxim was used in 1 case and in 3 cases Clindamycin was given without a medical history of Penicillin hypersensitivity. In the retrospective audit group PAP was administered in 22% for≤24 h); this was the case in 91% of the prospective group (p<0.001). No SSI was detected.
Conclusion:
This first comprehensive audit of PAP in a German POC outlines significant opportunities for improvement in terms of correct dosing, correct choice of the antibiotic, and shorter duration of PAP. In addition our results illustrate the challenges of optimising standard workflows in clinical practice.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...