The impact of a multimodel approach to designing a new orthopedic department

Elad Keren, Abraham Borer, Lior Nesher, Tali Shafat, Rivka Yosipovich, Ronit Nativ, Orly Shimoni, Orli Sagi, Lilia Greenshpoon, Lisa Saidel-Odes

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)937-942
Number of pages6
JournalInfection Control and Hospital Epidemiology
Volume42
Issue number8
DOIs
StatePublished - 1 Aug 2021
Externally publishedYes

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