title: Reinforcing good practice: Implementation of guidelines at hospital G. Pini.
abstract: BACKGROUND
  Surgical site infections (SSIs) in orthopaedic surgery are a demanding complication for the patient and in terms of economics. Many guidelines (GLs) are available on antibiotic prophylaxis as an effective preventive measure; however, these GLs are often ignored in practice. A surveillance study of SSIs in arthroplasty, promoted by the Italian Study Group of Hospital Hygiene of the Italian Society of Public Health (SitI), showed a high percentage of non-adherence to GLs on antibiotic prophylaxis.
  
  
  OBJECTIVE
  The purpose of this study was to review the existing GLs, share them within the hospital and then monitor their implementation.
  
  
  METHODS
  Information and training are considered to be great tools for implementation and sharing of GLs, which leads to significant improvements in clinical practice. A multidisciplinary team comprising infectious disease specialists, orthopaedic surgeons, nurse epidemiologists and public health specialists was established at the G. Pini Hospital in Milan to revise GLs, and to organise educational events for their implementation, sharing and dissemination. A checklist was devised for monitoring purposes.
  
  
  RESULTS
  GLs were presented to orthopaedic surgeons and nurse coordinators during two educational events. Meetings were organised in each unit to present the results of the surveillance of SSIs in arthroplasty and to discuss the reasons why the prophylaxis regimens adopted were not consistent with GLs. It was emphasised that the most important issue, on which there is consensus in the scientific literature, was related to the duration of prophylaxis beyond 24h. The review process for GLs was presented and pocket-sized GLs were given to surgeons. The importance of documenting on medical record any deviations from the GLs was emphasised.
  
  
  CONCLUSIONS
  Any changes in behaviour in clinical practice must be monitored and evaluated regularly. The monitoring of GLs in terms of correct choice of drug, timing of administration and duration of prophylaxis is made using a special checklist on a representative sample of medical records.
authors.affiliation: PhD Program in Public Health, Orthopaedic Institute, G. Pini - University of Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nobile
authors.affiliation: Postgraduate School in Public Health, University of Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bronzin
authors.affiliation: Orthopaedic Institute, G. Pini - University of Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Navone
authors.affiliation: Reparative Orthopaedic Surgery Department, Orthopaedic Institute, G. Pini - University of Milan, Italy. Electronic address: maz.colombo@hotmail.it.
authors.forename: M
authors.initials: M
authors.lastname: Colombo
authors.affiliation: Reparative Orthopaedic Surgery Department, Orthopaedic Institute, G. Pini - University of Milan, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Calori
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Auxilia
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001178:Arthroplasty / Q000009:adverse effects*; D057189:Checklist; D032921:Consensus; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D033183:Interdisciplinary Communication; D007558:Italy; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Arthroplasty; Surgical site infections; Surveillance