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Improved Perioperative Antibiotic Use and Reduced Surgical Wound Infections Through Use of Computer Decision Analysis

Published online by Cambridge University Press:  21 June 2016

Robert A. Larsen ,
R. Scott Evans ,
John P. Burke ,
Stanley L. Pestotnik ,
Reed M. Gardner  and
David C. Classen
Robert A. Larsen
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
R. Scott Evans*
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
John P. Burke
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
Stanley L. Pestotnik
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
Reed M. Gardner
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
David C. Classen
Affiliation:
Departments of Infectious Disease, Medical Informatics and Pharmacy, LDS Hospital; and University of Utah School of Medicine, Salt Lake City, Utah
*
Division of Inf ectious Disease, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143
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Abstract

A prospective study was performed over a two-year period to determine whether computer-generated reminders of perioperative antibiotic use could improve prescribing habits and reduce postoperative wound infections. During the first year, baseline patterns of antibiotic use and postoperative infection rates were established. During the second year, computer-generated reminders regarding perioperative antibiotic use were placed in the patient's medical record prior to surgery and patterns of antibiotic use and postoperative wound infections monitored.

Hospitalized patients undergoing non-emergency surgery from June to November 1985 (3,263 patients), and from June to November 1986 (3,568) were monitored with respect to indications for perioperative antibiotic use, timing of antibiotic use and postoperative infectious complications. Perioperative antibiotic use was considered advisable for 1,621 (50%) patients in the 1985 sample and for 1,830 (51%) patients in the 1986 sample. Among these patients, antibiotics were given within two hours before the surgical incision in 638 (40%) of the 1985 sample and 1,070 (58%) of the 1986 sample (p<0.001). Overall, postoperative wound infections were detected in 28 (1.8%) of 1,621 patients in 1985 compared with 16 (0.9%) of 1,830 such patients in 1986 (p<0.03).

We conclude that computer-generated reminders of perioperative antibiotic use improved prescribing habits with a concurrent decline in postoperative wound infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 7 , July 1989 , pp. 316 - 320
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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References

1. Burke, J: The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961;50:151–158.Google ScholarPubMed
2. Kaiser, AB: Antimicrobial prophylaxis in surgery. N Engl J Med. 1986;315:1129–1138.Google ScholarPubMed
3. Guglielmo, BJ, Hohn, DC, Koo, PJ, et al: Antibiotic prophylaxis in surgical procedures: A critical analysis of the literature. Arth Surg. 1983;118:943–955.10.1001/archsurg.1983.01390080045013CrossRefGoogle ScholarPubMed
4. Antimicrobial prophylaxis tor surgery. Med Lett Drugs Ther 1985;27:105–108.Google Scholar
5. Veterans Administration Ad Hoc Interdisciplinary Advisory Committee on Antimicrobial Drug Usage: Prophylaxis in surgery. JAMA. 1977;237:1003–1008.10.1001/jama.237.10.1003CrossRefGoogle Scholar
6. Chodak, GW, Plaut, MF: Use ot systemie antibiotics toi prophylaxis in surgery. Arth Surg 1977;112:326–333.10.1001/archsurg.1977.01370030098018CrossRefGoogle Scholar
7. Maki, DG, Schuna, AA: A study of antimicrobial misuse in a university hospital. Am J Med Sci. 1978;275:278–282.10.1097/00000441-197805000-00005CrossRefGoogle ScholarPubMed
8. Pryor, TA, Gardner, RM, Clavton, PD, et al: The HELP system. J Med Syst 1983;7:87–102.10.1007/BF00995116CrossRefGoogle ScholarPubMed
9. Hulse, RK, Clark, SJ, Jackson, JC, et al: Computerized medication monitoring system. Am J Hosp Pharm 1976;33:1061–1066.Google ScholarPubMed
10. Clayton, PD. Delaplaine, KH, Jensen, RD, et al: Integration of surgery management and clinical information systems. Proceedings oi the Eleventh Annual Symposium on Computer Applications in Medical Care, Washington, DC, November 1-4, 1987.Google Scholar
11. Evans, RS, Gardner, RM, Bush, AR, et al: Development of a computerized infectious disease monitor (CIDM). Comput Biomed Res. 1985;18:103–113.10.1016/0010-4809(85)90036-9CrossRefGoogle Scholar
12. Evans, RS, Larsen, RA, Burke, JP, et al: Computer surveillance of hospital-acquired infections and antibiotic use. JAMA. 1986;256:1007–1011.10.1001/jama.1986.03380080053027CrossRefGoogle ScholarPubMed
13. SENIC Project: Algorithms for diagnosing infections: Appendix E. Am J Epidemiol 1980;111:635–643.10.1093/oxfordjournals.aje.a112941CrossRefGoogle Scholar
14. National Research Council Division of Medical Sciences, Ad Hoc Committee: Postoperative wound infections: The influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964;160(suppl):1–21.Google Scholar
15. McDonald, CJ, Hui, SL, Smith, DM, et al: Reminders to physicians from an introspective computer medical record: A two-vear randomized trial. Ann Intern Med. 1984;100:130–138.10.7326/0003-4819-100-1-130CrossRefGoogle ScholarPubMed