Systematic review and evidence- based guidance ... - ECDC - Europa

Systematic review and evidence-based guidance on perioperative antibiotic prophylaxisTECHNICAL REPORTThe characteristics of the studies, their results and the grading of methodological quality/quality of evidence weresummarised 7 .Table 5. Distribution of included study design and geographical location of included studies,Objective 2Type of studyDistribution (world regions)Non-CBAs: n=16 (66.7%) North America: n=15Observational cohort studies: n=5 (20.8%) Europe: n=6RCTs: n=1 (4.2%) Asia: n=1ITS: n=1 (4.2%) Australia/New Zealand: n=1Scoping review: n=1 (4.2%) Middle East: n=1Total: N=24A scoping review identified factors and interventions that can influence PAP administration [66]. A scoping reviewis conducted with rigor comparable to a systematic review, but examines a broader question by reviewing a widerange of study designs. Gagliardi et al. included five studies which evaluated compliance with appropriateadministration of PAP as primary outcome, but did not evaluate the impact on SSI rate [66]. They concluded thatthe following measures improve compliance with appropriate PAP: implementation of multidisciplinaryprotocols/pathways; education or individualised performance feedback addressing clinician knowledge, attitudes,beliefs and behaviours; implementation of computerised decision-support programmes; and written orders for PAPkits, or pharmacist preparation of individualised PAP kits [66].In a RCT, Kritchevsky et al. investigated whether the implementation of a quality-improvement collaborativecombined with comparative feedback of performance data would increase compliance [67]. They included 44 USacute-care hospitals, each of which randomly sampled approximately 100 selected surgical cases (cardiac surgery,hip or knee replacement, hysterectomy) at both the baseline and re-measurement phases. All hospitals received acomparative feedback report. Hospitals randomly assigned to the intervention group (n=22) participated in aquality improvement collaborative comprising two in-person meetings led by experts, monthly teleconferences, andreceipt of supplemental materials over nine months. The groups did not differ in the change in proportion ofpatients who received a properly timed antimicrobial prophylaxis dose (−3.8 percentage points [95% CI, −13.9–6.2]) after adjustment for region, hospital size, and surgery type. Similarly, the groups did not differ in individualmeasures of antibiotic duration; use of appropriate drugs; receipt of a single preoperative dose; or an all-or-nonemeasure combining timing, duration and selection. The authors assumed that the hospitals volunteered for theeffort were motivated to change. They concluded that all included hospitals improved their compliance data forthese PAP measures by receiving a performance feedback that could not significantly improve by additionalparticipation in a quality-improvement collaborative.A CBA study by Ritchie et al. with moderate study quality was conducted in the orthopaedic service of twohospitals in New Zealand [68]. In order to reduce non-indicated, prolonged administration of PAP >24 h in patientsundergoing hip fracture surgery, a pre-printed prescription sticker was introduced and applied to the medicationchart by the anaesthetist when the initial dose of antibiotic was given. The number of patients who received threedoses according to the hospital guidelines increased from 29% to 74% (p