title: Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room.
abstract: OBJECTIVE
  To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations.
  
  
  METHODS
  Randomized, controlled, evaluator-blinded trial.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery.
  
  
  METHODS
  Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered.
  
  
  RESULTS
  Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02).
  
  
  CONCLUSIONS
  The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the CDC Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts, USA.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanetti
authors.forename: Hugh L
authors.initials: HL
authors.lastname: Flanagan
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: Richard
authors.initials: R
authors.lastname: Giardina
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
mesh_terms: D019072:Antibiotic Prophylaxis; D001331:Automation; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D004334:Drug Administration Schedule; D019983:Guideline Adherence; D006801:Humans; D007430:Intraoperative Care; D016017:Odds Ratio; D011785:Quality Assurance, Health Care; D017010:Reminder Systems; D016037:Single-Blind Method; D013530:Surgical Wound Infection / Q000517:prevention & control*