Quality improvements of antimicrobial prophylaxis in coronary artery bypass grafting.
BACKGROUND
Although the principles of antibiotics prophylaxis are well established, more than 60% of hospitals that joined the international quality indicator project failed to discontinue the use of prophylactic antibiotics within 24h after coronary artery bypass grafting (CABG). Our specific aims are to disseminate the gain obtained from breakthrough series model in knee arthroplasty and abdominal hysterectomy to increase the rate of prophylactic duration not longer than 24h in patients with CABG.


METHODS
The control and intervention groups enrolled 55 and 78 patients with CABG before and after the project. Measurements were prophylactic interval and duration, surgical site infection, hospital and antibiotics costs. Two strategies were developed. The key cardiac surgeon was invited to attend quality improvement activities. Knowledge and rationale of medical quality indicators would thus be communicated. Secondly, we proposed a regional symposium in which a level of competition was subconsciously established, and practitioners would present their level of compliance.


RESULTS
Instances of prophylactic interval within 1h prior to incision were significantly increased from 66.7% to 97.4%. Rates of prophylactic duration less than 24h were significantly increased from 2.8% to 66.1%. The average hospital cost was reduced by 16.4%, and antibiotics cost was reduced by 91.8%. No significant changes in surgical site infection within 30 d of CABG were observed.


CONCLUSIONS
We successfully disseminated the gain of breakthrough project in improving antimicrobial prophylaxis to CABG. By implementing this model, we are able to optimize the timing and duration of antimicrobial prophylaxis in patients with CABG to a level above worldwide average.
Sun
Tzong-Bor
TB
Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan. jtbsun@mail.tcu.edu.tw
Chao
Shen-Feng
SF
Chang
Bee-Song
BS
Chen
Tsung-Ying
TY
Gao
Pay-Yu
PY
Shyr
Ming-Hwang
MH
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000639:trends*; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D007391:International Cooperation; D007902:Length of Stay; D058996:Quality Improvement / Q000639:trends*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*; D013624:Taiwan; D013997:Time Factors
D000900:Anti-Bacterial Agents