The impact of a multimodel approach to designing a new orthopedic department
OBJECTIVE: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department.
DESIGN: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention.
SETTING: A 1,000-bed, tertiary-care, university hospital.
PATIENTS: Adult patients admitted to the orthopedics department between January 2015 and December 2018.
METHODS: During the preintervention period (2015-2016), 1 general orthopedic department was in operation. In the postintervention period (2017-2018), 2 separate departments were created: one designated for elective "clean" surgeries and another that included a "complicated wound" unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed.
RESULTS: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6-9) to the postintervention period (median, 4 days; IQR, 2-7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001).
CONCLUSIONS: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
|---|---|
| Enthalten in: |
Infection control and hospital epidemiology - 42(2021), 8 vom: 11. Aug., Seite 937-942 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Keren, Elad [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 06.09.2021 Date Revised 06.09.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1017/ice.2020.1345 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM318684071 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM318684071 | ||
| 003 | DE-627 | ||
| 005 | 20231225165851.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1017/ice.2020.1345 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1062.xml |
| 035 | |a (DE-627)NLM318684071 | ||
| 035 | |a (NLM)33303045 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Keren, Elad |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The impact of a multimodel approach to designing a new orthopedic department |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 06.09.2021 | ||
| 500 | |a Date Revised 06.09.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department | ||
| 520 | |a DESIGN: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention | ||
| 520 | |a SETTING: A 1,000-bed, tertiary-care, university hospital | ||
| 520 | |a PATIENTS: Adult patients admitted to the orthopedics department between January 2015 and December 2018 | ||
| 520 | |a METHODS: During the preintervention period (2015-2016), 1 general orthopedic department was in operation. In the postintervention period (2017-2018), 2 separate departments were created: one designated for elective "clean" surgeries and another that included a "complicated wound" unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed | ||
| 520 | |a RESULTS: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6-9) to the postintervention period (median, 4 days; IQR, 2-7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001) | ||
| 520 | |a CONCLUSIONS: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Borer, Abraham |e verfasserin |4 aut | |
| 700 | 1 | |a Nesher, Lior |e verfasserin |4 aut | |
| 700 | 1 | |a Shafat, Tali |e verfasserin |4 aut | |
| 700 | 1 | |a Yosipovich, Rivka |e verfasserin |4 aut | |
| 700 | 1 | |a Nativ, Ronit |e verfasserin |4 aut | |
| 700 | 1 | |a Shimoni, Orly |e verfasserin |4 aut | |
| 700 | 1 | |a Sagi, Orli |e verfasserin |4 aut | |
| 700 | 1 | |a Greenshpoon, Lilia |e verfasserin |4 aut | |
| 700 | 1 | |a Saidel-Odes, Lisa |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Infection control and hospital epidemiology |d 1988 |g 42(2021), 8 vom: 11. Aug., Seite 937-942 |w (DE-627)NLM012701467 |x 1559-6834 |7 nnns |
| 773 | 1 | 8 | |g volume:42 |g year:2021 |g number:8 |g day:11 |g month:08 |g pages:937-942 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1017/ice.2020.1345 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 42 |j 2021 |e 8 |b 11 |c 08 |h 937-942 | ||