Poster | By Goh CC et al.

Improving Standards of Surgical Prophylaxis in HSgB Neurosurgical Department Using PDSA Cycle

Background

Antibiotics prophylaxis is defined as the administration of antibiotics before contamination by a surgical incision has occurred, and it is given with the intention of preventing surgical site infection (SSI). SSIs are associated with prolonged in-patient hospital stays, longer antibiotics courses and increased cost to the health service.The administration of antibiotics prior to surgery is commonplace and of proven benefit in many circumstances to minimise postoperative SSIs. However, if not administered properly, antibiotics prophylaxis will not be effective and may be harmful. Antibiotics prophylaxis is indicated clearly for most clean and clean-contaminated operations.

 

 

Methods:

OT List was obtained to recruit patients who fulfill inclusion and exclusion criteria. Using case report form, details such as patient's demographic, surgical procedure and postoperative antibiotics were completed. Data collected was analysed using descriptive analysis. Interventions to improve surgical prophylaxis were then identified and proposed to team in-charge. Second PDSA cycle was then conducted. Data was collected and compared with the first PDSA cycle. Interventions according to second PDSA cycle was then identified and implemented.

Results:

3 PDSA cycles were conducted for Neurosurgical Department in HSgB. As a whole, percentage of appropriateness of surgical prophylaxis has improved throughout the 3 cycles; Cycle 1 6.7%, Cycle 2 18.8% and Cycle 3 33.3%. Inappropriateness categories were identified to be a) surgical prophylaxis indicated but not given, b) inappropriate timing, c) inappropriate duration, d) second dose indicated but not given and e) incomplete documentation (i.e no name, dose and/or administration time recorded). Percentage of inappropriateness had also decreased from Cycle 1 93.3% to Cycle 2 81.2% and Cycle 3 with significant improvement of 66.7%.

Conclusion:

a) Choice of antibiotics: S. aureus and coagulase-negative staphylococci are the most common microorganisms causing SSI in neurosurgical patients. Guidelines have recommended the use of Cefuroxime or Cefazolin as surgical prophylaxis. This study shows that doctors were aware that the choice of surgical prophylaxis should be Cefuroxime and not Ceftriaxone, as the PDSA cycles progressed. b) Timing of administration of antibiotics: Our study showed that administration time of surgical prophylaxis 60 minutes before first incision, improved as the cycle progressed. c) Duration of antibiotics: Prolonged surgical prophylaxis was not shown to be more beneficial in reducing SSI rate with the increased risk of Clostridium Difficile infection and development of resistant organisms. As cycles progressed, duration of surgical antibiotics administration had improved. d) Second dose indicated but not administered: Comparing Cycle 3 to the previous 2 cycles, surgeons improved in administering the intraoperative dose of antibiotics during prolonged surgery or major blood loss.

Our audit showed that PDSA cycles had improved the appropriateness of postoperative antibiotics administration in neurosurgical procedures in HSgB.