TY - JOUR
T1 - The impact of a multimodel approach to designing a new orthopedic department
AU - Keren, Elad
AU - Borer, Abraham
AU - Nesher, Lior
AU - Shafat, Tali
AU - Yosipovich, Rivka
AU - Nativ, Ronit
AU - Shimoni, Orly
AU - Sagi, Orli
AU - Greenshpoon, Lilia
AU - Saidel-Odes, Lisa
N1 - Funding Information:
Financial support. No financial support was provided relevant to this article.
Publisher Copyright:
© 2021 Cambridge University Press. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85112418391&partnerID=8YFLogxK
U2 - 10.1017/ice.2020.1345
DO - 10.1017/ice.2020.1345
M3 - Article
C2 - 33303045
AN - SCOPUS:85112418391
SN - 0899-823X
VL - 42
SP - 937
EP - 942
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 8
ER -
