Download - Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw
![Page 1: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/1.jpg)
Perioperative antibiotic prophylaxisPerioperative antibiotic prophylaxis subprojectsubproject
BARN 4th Workshop, 9-10 October 2013, WarsawBARN 4th Workshop, 9-10 October 2013, Warsaw
Hospital of Lithuanian University of Health Sciences Kauno Klinikos
Institute of Hygiene
dr.G.Gailiene
![Page 2: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/2.jpg)
• AimAim: To evaluate the quality of perioperative antibiotic prophylaxis (the adherence to the local prophylaxis guidelines) in the countries of Baltic Sea region.
• ObjectivesObjectives:– Evaluation of existing local AB stewardship; – Estimation of patients, who received AB within 1 hr – 15 min
prior to incision; – Estimation of patients, who received AB based on the local
guidelines;– Estimation of patients, who received AB after 24 hr;– Antibiotics used for prophylaxis;
![Page 3: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/3.jpg)
• Multicenter prospective observational study;
• Duration 2 weeks (10 working days);
• Pilot study was performed in November-December 2012 in General Surgery Department and Orthopedic Department of Hospital of Lithuanian University of Health Sciences Kauno Klinikos.
• Main study – March - June 2013 – in departments of:– Obstetric - Gynaecology, – Cardiosurgery;– General Surgery.
MethodsMethods
![Page 4: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/4.jpg)
PartParticipants of subprojecticipants of subproject: :
• Greta Gailiene, Zilvinas Dambrauskas, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Lithuania;
• Uga Dumpis, Aija Vilde, Pauls Stradini University Hospital, Latvia;
• Piret Mitt, Tartu University Hospital, Estonia;
• Pille Martin, West - Tallinn Central Hospital, Estonia;
• Birgitta Lytsy, Uppsala University Hospital, Sweden.
![Page 5: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/5.jpg)
General dataGeneral data Number of beds Hospital of
Lithuanian University of
Health Sciences Kauno Klinikos
(Lithuania)LTLT
Stradins University Hospital
(Latvia)LVLV
Tartu University Hospital
(Estonia) EEEE
West - Tallinn Central
Hospital
(Estonia)EE2EE2
Uppsala University Hospital
(Sweden)SESE
Hospital 1947 822 975 481 1100
ABDOMINAL department
90 75 66 44 -
OBSTETRIC-GYNAECOLOGY
department
60 22 17 55 -
CARDIOSURGERY department
40 46 30 - 25
![Page 6: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/6.jpg)
ResultsResults
![Page 7: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/7.jpg)
AB stewardshipAB stewardship
0 1 2 3 4 5 6
A re meas ures taken to improve c omplianc e?
A re data on c omplianc e fed bac k to the hos pitaladminis tration?
A re data on c omplianc e fed bac k to the s urgic aldepartments ?
A re a s uffic ient number of s urgic al proc eduresinc luded in an audit of P A P ?
Were one or more audits for c omplianc e with the P A Pprotoc ol performed?
Is the hos pital P A P protoc ol regularly updated?
Were the s urgic al proc edures evaluated ac c ording toappropriatenes s of P A P indic ation?
A re patient-s pec ific fac tors taken into c ons iderationwhen updating the P A P -protoc ol?
Is the P A P protoc ol updated + ac c ording to the loc alantimic robial s us c eptibility patterns ?
A B prophylax is guidelines define:
A B prophylax is guidelines s tatus :obligatory
A B prophylax is guidelines s tatus :rec ommendation
Does the A B team have one or more annual plenarymeetings ?
Is there a multidis c iplinary A B -team that c ons is ts ofprofes s ionals from relevant areas ?
Y es
No
•AB doses•AB prescription duration •route of AB administrationalternative AB
SE 2(LV,SE)
3 (LT,EE,EE2)
3(EE,EE2,SE), 2 (LV,LT)
3(EE,EE2,SE)
2 (LV,LT)
3(EE,SE,EE
2) 2(LV,LT) 2(EE,EE2) 3(LV,LT,SE)
3(EE,EE2,SE)
2(LV,LT)
2(EE,EE2);3(LV,LT,SE)
![Page 8: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/8.jpg)
Obstetric – gynaecology Obstetric – gynaecology Types of surgery (N)Types of surgery (N)
![Page 9: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/9.jpg)
Obstetric – gynaecology surgeryObstetric – gynaecology surgeryAB prophylaxis (%)AB prophylaxis (%)
100
0
95.45
0 0 0
98.48
0
55.56
5.56
61.11
05.56
0
22.22
0
18.75
75.068.75
0 0 0 4.35 09.1
40.9
85.71
0 0 0
27.2716.67
0
20
40
60
80
100
120
Patientreceived
AB within 1hr prior toincision
PatientreceivedAB within
15 - 30 minprior toincision
PatientreceivedAB based
on theGuidelines
(first ABdose)
PatientreceivedAB based
on theGuidelines(second AB
dose)
Second ABdose due toprolongedoperation
Second ABdose due toblood loss
(≥1,5 L)
Patientreceived
AB after 24hr
* Patientreceived
AB after 24hr based on
theGuidelines
L T
L V
E E
E E (2)
*LV - 38.9 % patients received AB more than 1 hr prior to incision;
** EE - 1 (4.3%) patient received AB 8 min after incision; 30.4% patients did not received AB before operations (PAP is indicated only for hysterectomy, but 4 (out of 10) patients with ovarian surgery received PAP);
*** EE (2) 45.4 % patients received AB more than 1 hr prior to incision, 4.5% patients did not received AB.
![Page 10: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/10.jpg)
AB used for prophylaxis before Obstetric-AB used for prophylaxis before Obstetric- g gynaecology surgery (%)ynaecology surgery (%)
0
10
20
30
40
50
60
70
80
90
100
LT
LV
EE
EE2
![Page 11: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/11.jpg)
CardiosurgeryCardiosurgeryTypes of surgery (N)Types of surgery (N)
![Page 12: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/12.jpg)
CardiosurgeryCardiosurgery
AB prophylaxis (%)AB prophylaxis (%)
* LV - 52.2 % patients received AB more than 1 hr prior to incision
32.0
0.0
24.0
0.0
21.4
78.6
0.0 0.0
64.29
35.71
100.0
28.57 25.0
47.83
0.0
47.83
93.75
0.0
100.0
68.0
100.0 100.0
0
20
40
60
80
100
120
P atientrec eived A Bwithin 1 hr
prior toinc is ion
P atientrec eived A B
within 15 - 30min prior to
inc is ion
P atientrec eived A B
bas ed on theG uidelines
(firs t A B dos e)
P atientrec eived A B
bas ed on theG uidelines
(s ec ond A Bdos e)
P atientrec eived A B
after 24 hr
*P atientrec eived A B
after 24 hrbas ed on the
G uidelines
L T
E E
S E
L V
![Page 13: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/13.jpg)
AB used for prophylaxis before Cardiosurgery (%)AB used for prophylaxis before Cardiosurgery (%)
0102030405060708090
100
LT
LV
EE
SE
![Page 14: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/14.jpg)
Abdominal surgeryAbdominal surgery Types of surgery (N)Types of surgery (N)
![Page 15: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/15.jpg)
Abdominal surgeryAbdominal surgery
AB prophylaxis (%)AB prophylaxis (%) 100.0
0.0
100.0
0.012.90
0.013.04
86.67 82.61
100.0
56.52
0.04.2
41.6
100.0 100.0
0.0 0.012.90
77.4267.74
0.0
81.25
0.00.0
20.0
40.0
60.0
80.0
100.0
120.0
Patie ntre c e ive d A Bw ithin 1 hr
pr ior toinc is ion
Patie ntre c e ive d A B
w ithin 15 -30 m in pr ior
to inc is ion
Patie ntre c e ive d A B
bas e d onthe
Guide line s(firs t A B
dos e )
Patie ntre c e ive d A B
bas e d onthe
Guide line s(s e c ond A B
dos e )
Patie ntre c e ive d A B
afte r 24 hr
*Patie ntre c e ive d A B
afte r 24 hrbas e d on
theGuide line s
L T
E E
E E (2)
L V
*EE - 1 (2.2%) patient received AB after incision;
** EE (2) - 12.5% patients received first dose of AB on time of incision or after incision; 41.6 % patients did not received AB before operations;
*** LV - 9.7 % patients received AB after incision.
![Page 16: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/16.jpg)
0
10
20
30
40
50
60
70
80
90
LTLVEEEE2
AB used for prophylaxis before Abdominal surgery (%)AB used for prophylaxis before Abdominal surgery (%)
![Page 17: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/17.jpg)
AB appointment before surgery (%)AB appointment before surgery (%)
Surgery LTLT LVLV EEEE EE2EE2 SESE
Obstetric-gynaecology
Anesthesiologist+Surgeon – 100%
Surgeon – 100%
AnesthesioloAnesthesiologist– 100% gist– 100%
Surgeon – 100%
-
Cardiosurgery Anesthesiologist - 96%
Surgeon – 4 %
Anesthesiologist–
100%
AnesthesioloAnesthesiologist– 100% gist– 100%
- Anesthesiologist – 100%
Abdominal Anesthesiologist+Surgeon – 100%
Anesthesiologist+Surg
eon – 100%
AnesthesioloAnesthesiologist– 100% gist– 100%
Anesthesiologist– 84.6%
Surgeon – 15.4%
-
![Page 18: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/18.jpg)
ResumeResume::• Multidisciplinary AB-team has only one hospital (20.0%).
• PAP protocol updated according to the local antimicrobial susceptibility patterns in 3 hospitals (60.0%).
• One or more audits for compliance with the PAP protocol are performed in 2 hospitals (40.0%).
• Antibiotic timing (1 h or 15 - 30min.) and appointment (surgeon or anesthesiologist, or both) before operation depends on the type of surgery, i.e. depends on ward, but not on hospital (except Tartu university hospital).
• Patients received AB more than 1 hr prior incision in 2 hospitals, in 3 hospitals - AB after incision.
• 4.35 – 98.5 % of patient received AB after 24 hr in all (5) hospitals, based on the Guidelines – in 2 hospitals.
• 1st and 2nd gen cephalosporins or combinations with other antibiotics were used most common for prophylaxis.
![Page 19: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/19.jpg)
RecommendationsRecommendations
• Repeat study;
• Expand:– number of participating:
• persons• departments• countries
– duration of study– protocol (AB name, dose, precise injection or
oral administration time)
![Page 20: Perioperative antibiotic prophylaxis subproject BARN 4th Workshop, 9-10 October 2013, Warsaw](https://reader036.vdocuments.us/reader036/viewer/2022062315/568150a0550346895dbe9dac/html5/thumbnails/20.jpg)
Thank you for attentionThank you for attention