• Ешқандай Нәтиже Табылған Жоқ

Compliance of antibiotic prophylaxis therapy with clinical protocols.

N/A
N/A
Protected

Academic year: 2023

Share "Compliance of antibiotic prophylaxis therapy with clinical protocols."

Copied!
30
0
0

Толық мәтін

(1)

Compliance of antibiotic prophylaxis therapy with clinical protocols at the

National Research Center of

Oncology and Transplantology in Astana: retrospective cohort study

MPH candidate: Raushan Bizhigitova

Nazarbayev University School of Medicine

Master of Public Health Program

(2)

Antibiotic prophylaxis therapy

Antibiotic prophylaxis therapy – a crucial procedure before undergoing any surgical interventions that is used to decrease the occurrence of

surgical site infections and, thus, minimize postoperative morbidity, mortality and reduce hospitalization time.

• Key components of Antibiotic prophylaxis therapy

→ Appropriate antibiotic drug

→ Correctly defined time and dosages of antibiotic therapy

→ Preoperative and postoperative antibiotic administration

(Page, 1993)

2

(3)

Consequences of inappropriate antibiotic prophylaxis therapy

• Inappropriate use of antibiotics before surgery might lead to:

development of surgical site infections

occurrence of medication errors. (Bratzler et al., 2005)

• Surgical site infection accounts for 22% of hospital-acquired infections in USA that is associated with increased morbidity, mortality,

readmissions, and prolonged hospital stay (Jonge et al., 2017) .

• Each year at least 1.3 million people have postoperative complications

due to medication errors in USA (WHO, 2017) .

(4)

Intervention

• Republican center for Health development (RCHD, 2016)

→ develop clinical protocols with detailed instructions for antibiotic use in various diseases based on best world practices

• World Health Organization (WHO, 2007)

→ evidence-based guidelines of safe antibiotic administration for patients that need surgical interventions

→ surgical safety checklist

4

(5)

Key criteria to assess compliance of Antibiotic prophylaxis therapy

(1) Antibiotic introduction to patient prior to and

after surgical intervention

(2) Correct

antibiotic dosage for first dose

(3) Time of

administration of the first dose (between

30 and 60 minutes before surgery)

(4) Correct

antibiotic dosage for second dose

(5) Time of

administration of the second dose

(between 8 and 24

hours after surgery)

(6)

Importance of the study

• Occurrence of surgical site infections due to incorrect antibiotic therapy is high (Jonge et al., 2017).

• Reported number of verbally given prescriptions of antibiotic to nurses and number of undocumented antibiotic administration among health professionals (Committee on Patient Safety and Quality Improvement, 2010)

Limited studies on the problem of compliance of antibiotic prophylaxis therapy with clinical protocols

→ No similar studies published in Kazakhstan

6

(7)

1. To identify the level of compliance of antibiotic

prophylaxis with clinical protocols and guidelines in National Research Center of Oncology and

Transplantology within 2015-2017

2. To highlight the role of the clinical protocols in providing correct antibiotic prophylaxis

Study objectives

(8)

• Retrospective cohort study (January 2015 – December 2017)

• Approved by the research ethical committee of

Nazarbayev University School of Medicine and ethical committee of University Medical Center.

Study Design

• Inclusion criteria: patients elder than 18 years old

receiving antibiotics before and after surgery between 2015 and 2017 in the Department of orthopedics

• Exclusion criteria: incomplete medical records Study

population

• 180 medical records were analyzed

• Examining doctor’s prescriptions, drugs/procedures appointment sheet, surgical and anesthesiology

records and preoperative checklist Sample Size

Data Collection

Methods (1)

(9)

• Key criteria of compliance of Antibiotic prophylaxis therapy with clinical protocols:

• Antibiotic introduction prior to and after the surgery

• Correct time and dose of antibiotic prior to and after the surgery

Study Instrument

• Age, gender, type, dose and time of antibiotics

• The level of compliance of Antibiotic

prophylaxis therapy with clinical protocols and WHO guidelines

Independent Variables

Outcome Variable

• Univariate, Bivariate (Chi-square test)

• Statistical significance p-value <0.05

• Stata software (StataCorp, 2013)

Statistical Analysis

Methods (2)

(10)

Results: Socio-demographic characteristics

26%

52%

22%

Disease

Coxarthrosis (hip joint disease)

Gonarthrosis (knee joint disease)

Other

7% 11%

32%

50%

Age

18-29 30-44 45-59 60<

30%

70%

Gender

Male Female

10

(11)

Compliance of Antibiotic prophylaxis therapy with Clinical protocols and guidelines

Criterion No.

available

Compliance No. of compliant

medical records % 95% CI

1. Compliance of chosen antibiotic 180 153 85.0 82.9-95.9

2. Correct time of administration of the first dose

3. Correct antibiotic dosage for the first dose

4. Correct time of administration of the second dose

5. Correct antibiotic dosage for the second dose

180 180 180 180

76 152 142 163

42.2

84.4 78.9 90.6

34.9-49.5 79.1-89.8 72.9-84.9 86.2-94.9 Total duration of antibiotic prophylaxis ≤

24 hours

180 170 94.4 91.1-97.8

Full compliance * 180 58 32.2 25.3-39.1

(12)

Compliance of Antibiotic prophylaxis therapy with Clinical protocols and guidelines in 2015-2017

Actions

2015 (n = 60) 2016 (n = 60) 2017 (n = 60)

C NC p C NC p C NC P

Antibiotic

Cefazolin 15 36

0.294

15 30

0.024

25 25

0.014

Ceftriaxone 1 2 2 1 0 0

Lincomycin 0 0 0 0 0 1

No antibiotic agent 0 6 0 12 0 9

First dose

Intraoperative administration 0 2

< 0.001

0 5

< 0.001

0 6

< 0.001

Preoperative administration, < 30 min 0 5 0 9 0 10

Preoperative administration, 30-60 min 16 3 17 9 25 5

Preoperative administration, > 60 min 0 26 0 0 0 0

No antibiotic prophylaxis 0 8 0 20 0 14

Second dose

Postoperative administration, < 8 h 0 5

0.578

0 0

0.002

0 0

0.417

Postoperative administration, 8-24 h 16 34 17 25 25 25

Postoperative administration, > 24 h 0 0 0 0 0 2

No antibiotic prophylaxis 0 5 0 18 0 8

* C – compliant, NC – not compliant

12

(13)

Full compliance of Antibiotic prophylaxis therapy with clinical protocols and guidelines by year

Full compliance No. available % of compliant medical records

95% CI P

By year 2015 2016 2017

60 60 60

26.67 (16) 28.33 (17) 41.67 (25)

0.151-0.382 0.166-0.401 0.288-0.545

0.156

(14)

Discussion

• Most compliant criteria – “Dosages of preoperative and postoperative antibiotic

administration”

• Least compliant criterion – “Time of preoperative antibiotic administration”

→ Preoperative antibiotic prophylaxis therapy improves patient`s condition (Vries et al., 2010)

→ Preoperative antibiotic prophylaxis therapy has significant effect on reducing Surgical site infections (Giusti et al., 2016)

14

(15)

26.7%

28.3%

41.7%

2015 2016 2017

Full compliance of Antibiotic prophylaxis therapy by year

Discussion

• Introduction of updated surgical checklist in November, 2016 at the

National Research Center of Oncology and Transplantology based

on physician feedback, occurrence of patient readmission and

(16)

Discussion

85.0% 84.4%

42.2%

32.2%

15,00%

71.0%

98.0%

80.0%

53.0%

5,00%

Correctly chosen Antibiotic

Correct dose of the first antibiotic administration

Correct time of the first antibiotic administration

Full compliance of antibiotic prophylaxis

therapy

No antibiotic prophylaxis therapy

received

Level of Compliance of Antibiotic Prophylaxis Therapy with Clinical protocols: Kazakhstan vs France

Kazakhstan France

16

Needs Attention!

(Bedouch et al., 2004)

(17)

Discussion: Strengths

• Study findings allow us:

→ to see the situation in hospitals

→ to increase the awareness of anesthesiologists on Antibiotic prophylaxis therapy compliance

→ to improve adherence to safety guidelines which is required by many accreditation services

→ to monitor the compliance of Antibiotic prophylaxis

therapy procedures with WHO guidelines and Clinical protocols

(18)

Discussion: Weaknesses

• Quality of dataset

→ unclear handwritten documentation about antibiotic use

• Small sample size

→ 180 medical records were analyzed instead of expected 300 medical records

• Data is limited to only one hospital

18

(19)

Discussion: Recommendations

• The study can be expanded to all departments of the center to compare the level of compliance with Clinical protocols

among National Research Center of Oncology and Transplantology departments.

Mixed method study can be conducted which will include qualitative interviews of anesthesiologists, surgeons and nurses and quantitative analysis of medical records of

patients.

(20)

Соблюдение антибиотикопрофилактики согласно клиническим протоколам в

Национальном научном центре онкологии и трансплантологии в г. Астана:

ретроспективное когортное исследование

Кандидат МРН: Раушан Бижигитова

Научный руководитель: Алпамыс Исанов, MD, MPH

Школа Медицины Назарбаев Университета

Программа Общественного Здравоохранения

(21)

Введение

Антибиотикопрофилактика – процедура, используемая перед каким- либо хирургическим вмешательством для уменьшения числа

хирургических инфекций, сокращения послеоперационной

заболеваемости, смертности и времени госпитализации. (Page, 1993)

• Клинические протоколы и методические рекомендации на основе

лучших мировых практик с подробным описанием по применению

антибиотиков при различных заболеваниях помогают снизить риск

распространения хирургических инфекций (RCHD, 2016; WHO, 2007)

(22)

Ключевые критерии для оценки соответствия антибиотикопрофилактики клиническим

протоколам

(1) Введение

антибиотика пациенту до и после

хирургического вмешательства

(2) Правильная дозировка антибиотиков до

операции

(3) Правильное время введения

антибиотиков до операции (в период между 30-60 мин до

операции)

(4) Правильная

дозировка антибиотиков после операции

(5) Правильное время введения антибиотиков после операции (в период

между 8-24 ч после операции)

(ВОЗ, 2007)

22

(23)

1. Определить уровень соответствия

антибиотикопрофилактики клиническим протоколам и методическим рекомендациям в Национальном

научном центре онкологии и трансплантологии в 2015-2017 гг.

2. Определить роль клинических протоколов в

обеспечении правильной антибиотикопрофилактики

Цели исследования

(24)

Методы

• Ретроспективное когортное исследование (Январь, 2015 – Декабрь, 2017)

Образец исследования – 180 медицинских карт:

→ Критерии включения: пациенты старше 18 лет, получающие

антибиотики до и после операции в период между 2015 и 2017 годами в Отделе Ортопедии

→ Критерии исключения: неполные медицинские записи

Независимые переменные: вид, доза, время введения антибиотика

Зависимая переменная: Уровень соответствия

антибиотикопрофилактики клиническим протоколам и рекомендациям ВОЗ

24

(25)

• Более соблюдаемый критерий – «Дозировка предоперационного и послеоперационного введения антибиотиков»

• Менее соблюдаемый критерий – «Время предоперационного введения антибиотиков»

Полное соблюдение антибиотикопрофилактики согласно клиническим протоколам и рекомендациям ВОЗ – 32,2%

Рост полного соблюдения антибиотикопрофилактики в 2015-2017 годах – с 26,7% до 41,7%

Результаты исследования

(26)

Обсуждение

• Важность предоперационной антибиотикопрофилактики:

→ Улучшает состояние пациента (Vries et al., 2010)

→ Оказывает существенное влияние на снижение хирургических инфекций (Giusti et al., 2016)

26

(27)

Обсуждение

85.0% 84.4%

42.2%

32.2%

15,00%

71.0%

98.0%

80.0%

53.0%

5,00%

Правильный выбор антибиотика

Правильная доза для предоперационного

Правильное время для предоперационного

Полное соответствие антибиотикопрофилактики

Отсутствие

антибиотикопрофилактики

Уровень соблюдения антибиотикопрофилактики согласно клиническим протоколам: Казахстан и Франция

Казахстан Франция

(28)

Рекомендации

• Проведение исследования во всех отделениях Национального научного центра онкологии и

трансплантологии, чтобы сравнить уровень соблюдения клинических протоколов.

• Проведение смешанного метода исследования, который будет включать качественные интервью анестезиологов, хирургов и медсестер и количественный анализ

медицинских записей пациентов.

28

(29)
(30)

References

Bedouch, P., Labarère, J., Chirpaz, E., Allenet, B., Lepape, A., & Fourny, M. et al. (2004). Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital. Infection Control & Hospital Epidemiology, 25(04), 302-307.

http://dx.doi.org/10.1086/502396

Bratzler, D., Houck, P., Richards, C., & Steele, L. (2005). Use of Antimicrobial Prophylaxis for Major Surgery. Archives Of Surgery, 140(2), 174.

http://dx.doi.org/10.1001/archsurg.140.2.174

Committee opinion no. 464: Patient safety in the surgical environment. (2010, September). Retrieved April 01, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/20733473

Giusti, A., Spila Alegiani, S., Ciofi degli Atti, M., Colaceci, S., Raschetti, R., & Arace, P. (2016). Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes. BMC Pediatrics, 16(1). http://dx.doi.org/10.1186/s12887-016-0739-y

Jonge, S., Gans, S., Atema, J., Solomkin, J., Dellinger, P., & Boermeester, M. (2017). Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection.Medicine,96(29), e6903. http://dx.doi.org/10.1097/md.0000000000006903

Page, C. (1993). Antimicrobial Prophylaxis for Surgical Wounds.Archives Of Surgery,128(1), 79. http://dx.doi.org/10.1001/archsurg.1993.01420130087014 RCHD(2016). Регламент по разработке/пересмотру клинических протоколов. РГП на ПХВ «Республиканский центр развития здравоохранения».

Retrieved April 01, 2018, from http://online.zakon.kz/Document/?doc_id=34359829 StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.

Vries, E. N., Dijkstra, L., Smorenburg, S. M., Meijer, R. P., & Boermeester, M. A. (2010). Retrieved April 01, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867812/

WHO (2017, March 29). WHO Launches Global Effort to Halve Medication-Related Errors in 5 Years. Retrieved April 01, 2018, from http://www.who.int/mediacentre/news/releases/2017/medication-related-errors/en/

WHO (2007). Best Practice Safety Protocols: Clinical procedures safety. Retrieved April 01, 2018, from http://www.who.int/surgery/publications/immesc_best_practice/en/

30

Ақпарат көздері

СӘЙКЕС КЕЛЕТІН ҚҰЖАТТАР