title: Implementing a standardized perioperative antibiotic prophylaxis protocol for neonates undergoing cardiac surgery.
abstract: BACKGROUND
  A lack of perioperative antibiotic prophylaxis guidelines for neonates undergoing cardiac surgery has resulted in a wide variation in practice. We sought to do the following: (1) Determine the safety of a perioperative antibiotic prophylaxis protocol for neonatal cardiac surgery as measured by surgical site infections (SSIs) rates before and after implementation of the protocol; and (2) evaluate compliance with selected process measures for perioperative antibiotic prophylaxis.
  
  
  METHODS
  This quasi-experimental study included all cardiac procedures performed on neonates from July 2009 to June 2012 at a single center. An interdisciplinary task force developed a standardized perioperative antibiotic prophylaxis protocol in the fourth quarter of 2010. The SSI rates were compared in the preintervention (July 2009 to December 2010) versus the postintervention periods (January 2011 to June 2012). Compliance with process measures (appropriate drug, dose, timing, and discontinuation of perioperative antibiotic prophylaxis) was compared in the 2 periods.
  
  
  RESULTS
  During the study period, 283 cardiac procedures were performed. The SSI rates were similar in the preintervention and postintervention periods (6.21 vs 5.80 per 100 procedures, respectively). Compliance with the 4 process measures significantly improved postintervention.
  
  
  CONCLUSIONS
  Restricting the duration of perioperative antibiotic prophylaxis after neonatal cardiac surgery to 48 hours in neonates with a closed sternum and to 24 hours after sternal closure was safe and did not increase the rate of SSIs. Compliance with selected process measures improved in the postintervention period. Additional multicenter studies are needed to develop national guidelines for perioperative prophylaxis for this population.
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, New York.
authors.forename: Meghan T
authors.initials: MT
authors.lastname: Murray
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, New York; Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Rozelle
authors.initials: R
authors.lastname: Corda
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Turcotte
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York; Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York. Electronic address: gk2008@columbia.edu.
authors.forename: Ganga
authors.initials: G
authors.lastname: Krishnamurthy
mesh_terms: D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000592:standards*; D006348:Cardiac Surgical Procedures; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control