Success of an infection control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance

BACKGROUND: SSIs develop in up to 5% of surgical patients in the United States, with half of these being preventable if SAP is used judiciously. Overuse and misuse of SAP has a potential to contribute significantly to the emerging problem of antimicrobial resistance. To increase compliance with evidence-based guidelines, the Centers for Disease Control and Prevention (CDC) has launched a campaign to Prevent Antimicrobial Resistance in Surgical Patients, emphasizing wise use of antimicrobials as one of the key strategies. OBJECTIVES: To participate in Texas Medical Foundation Surgical Infection Prevention (SIP) Medicare Quality Improvement Project, with a goal of achieving >90% compliance with three core measures: 1) administration of antibiotic within 1 hour preceding surgical incision, 2) use of appropriate antibiotic and dosing, and 3) discontinuation of prophylactic antibiotic within 24 hours of surgery. METHODS: A multidisciplinary team consisting of the following departments: infection control (IC), clinical outcomes, nursing, operating room (OR) nurse educator, pharmacy, and physicians (infectious diseases, anesthesia, and surgery) was formed to develop practical ways to implement the SIP measures in the orthopedic and neurosurgical populations. Recommendations for appropriate SAP based on national guidelines were discussed with the surgeons and anesthesiologists. A laminated page with the protocol was made available on each anesthesia cart. IC and OR participated in ongoing education campaigns to the nursing staff. A data collection tool to be completed by the peri-operative team was formulated, and OR nurse educator followed-up daily to ensure accurate documentation. Rates were analyzed by IC, discussed in monthly SIP meetings, and posted on a showcase in a conspicuous OR location. Reasons for fall-out were scrutinized, and individual feedback on outliers provided to the physicians. RESULTS: Compliance rates from November 2003 (baseline) to November 2004, improved for all three indicators: 1) timely administration of prophylactic antibiotic, 84.6% to 91.1% (p = 0.5); 2) appropriate antibiotic and dosage, 69.2% to 97.8% (p CONCLUSIONS: A multidisciplinary approach focusing on practical strategies for implementation of evidence-based practices for SAP led to our programs success and recognition in 2004 by Texas Medical Foundation for achieving >90% compliance for all three SIP measures.