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Pedersen PU, Tracey A, Sindby JE, Bjerrum M. Preoperative oral hygiene recommendation before open-heart surgery: patients' adherence and reduction of infections: a quality improvement study. BMJ Open Qual 2019; 8:e000512. [PMID: 31206058 PMCID: PMC6542424 DOI: 10.1136/bmjoq-2018-000512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 01/08/2023] Open
Abstract
Aim To implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced. Background Healthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline. Methods A quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients’ medical records. Data were reported as intention to treat. Results Altogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively. Conclusions It was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.
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Affiliation(s)
- Preben Ulrich Pedersen
- Aalborg University, Department of Clinical Medicine, Centre of Clinical Guidelines and Clinical Research Unit, Aalbirg University Hospital, Aalborg University, Aalborg, Denmark
| | - Anita Tracey
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Eske Sindby
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Merete Bjerrum
- Section of Nursing Research, Aarhus Universitet, Aarhus, Denmark
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van Oostveen RB, Romero-Palacios A, Whitlock R, Lee SF, Connolly S, Carignan A, Mazer CD, Loeb M, Mertz D. Prevention of Infections in Cardiac Surgery study (PICS): study protocol for a pragmatic cluster-randomized factorial crossover pilot trial. Trials 2018; 19:688. [PMID: 30558680 PMCID: PMC6296086 DOI: 10.1186/s13063-018-3080-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
Background A wide range of prophylactic antibiotic regimens are used for patients undergoing open-heart cardiac surgery. This reflects clinical equipoise in choice and duration of antibiotic agents. Although individual-level randomized control trials (RCT) are considered the gold standard when evaluating the efficacy of an intervention, this approach is highly resource intensive and a cluster RCT can be more appropriate for testing clinical effectiveness in a real-world setting. Methods/design We are conducting a factorial cluster-randomized crossover pilot trial in cardiac surgery patients to evaluate the feasibility of this design for a definite trial to evaluate the optimal duration and choice of perioperative antibiotic prophylaxis. Specifically, we will evaluate: (a) the non-inferiority of a single preoperative dose compared to prolonged prophylaxis and (b) the potential superiority of adding vancomycin to routine cefazolin in terms of preventing deep and organ/space sternal surgical site infections (s-SSIs). There are four strategies: (i) short-term cefazolin, (ii) long-term cefazolin, (iii) short-term cefazolin + vancomycin, and (iv) long-term cefazolin + vancomycin. These strategies are delivered in a different order in each health-care center participating in the trial. The centers are randomized to an order, and the current strategy becomes the standard operating procedure in that center during the study. The three feasibility outcomes include: (1) the proportion of patients receiving preoperative, intra-operative, and postoperative antibiotics according to the study protocol, (2) the proportion of completed follow-up assessments, and (3) a full and final assessment of the incidence of s-SSIs by the outcome adjudication committee. Discussion We believe that a cluster-randomized factorial crossover trial is an effective and feasible design for these research questions, allowing an evaluation of the clinical effectiveness in a real-world setting. A waiver of individual informed consent was considered appropriate by the research ethics boards in each participating site in Canada as long as an information letter with an opt-out option was provided. However, a waiver of consent was not approved at two sites in Germany and Switzerland, respectively. Trial registration Clinicaltrials.gov, NCT02285140. Registered on 15 October 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-3080-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel B van Oostveen
- Population Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Richard Whitlock
- Population Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Shun Fu Lee
- Population Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada
| | - Stuart Connolly
- Population Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - C David Mazer
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mark Loeb
- McMaster University, Hamilton, ON, Canada
| | - Dominik Mertz
- Population Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON, Canada. .,McMaster University, Hamilton, ON, Canada. .,Juravinski Hospital and Cancer Center, 711 Concession Street, Section M, Level 1, Room 3, Hamilton, ON, L8V 1C3, Canada.
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Ashfaq A, Zhu A, Iyengar A, Wu H, Humphries R, McKinnell JA, Shemin R, Benharash P. Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery. J Card Surg 2016; 31:367-72. [DOI: 10.1111/jocs.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Adeel Ashfaq
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Allen Zhu
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Amit Iyengar
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Hoover Wu
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Romney Humphries
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - James A. McKinnell
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Richard Shemin
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Peyman Benharash
- Division of Cardiac Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
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