Hostname: page-component-77c89778f8-cnmwb Total loading time: 0 Render date: 2024-07-21T11:31:33.387Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 December 2020

Elad Keren ,
Abraham Borer ,
Lior Nesher ,
Tali Shafat ,
Rivka Yosipovich ,
Ronit Nativ ,
Orly Shimoni ,
Orli Sagi ,
Lilia Greenshpoon  and
Lisa Saidel-Odes Open the ORCID record for Lisa Saidel-Odes [Opens in a new window]
Elad Keren
Affiliation:
Orthopedic Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Abraham Borer
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lior Nesher
Affiliation:
Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tali Shafat
Affiliation:
Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Rivka Yosipovich
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
Ronit Nativ
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
Orly Shimoni
Affiliation:
Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orli Sagi
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lilia Greenshpoon
Affiliation:
Orthopedic Department, Soroka University Medical Center, Beer-Sheva, Israel
Lisa Saidel-Odes*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Author for correspondence: Dr Lisa Saidel-Odes, E-mail: lisasod@clalit.org.il
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 8 , August 2021 , pp. 937 - 942
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: This work was presented in part as an oral presentation (no. 1303) at the APIC 2019 Annual Conference on June 13, 2019, in Philadelphia, Pennsylvania.

References

VanSteelandt, A, Conly, J, Ghali, W, Mather, C. Implications of design on infection prevention and control practice in a novel hospital unit: the medical ward of the twenty-first century. Anthropol Med 2015;22:149–161.CrossRefGoogle Scholar
Ulrich, R, Quan, X, Zimring, C, Joseph, A, Choudhary, R. The role of the physical environment in the hospital of the twenty-first century: a once-in-a-lifetime opportunity. The Center for Health Design website. http://www.healthdesign.org/research/reports/pdfs/role_physical_env.pdf. Accessed November 23, 2020.Google Scholar
Mueller Bartley, J, The 1997, 1998, and 1999 APIC Guidelines committees. APIC State-of-the-Art Report: the role of infection control during construction in health care facilities. Am J Infect Control 2000;28:156–169.CrossRefGoogle Scholar
Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:605–627.CrossRefGoogle ScholarPubMed
Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183–189.CrossRefGoogle Scholar
Maksimović, J, Matkovic-Denić, L, Bumbasirević, M, Marinković, J, Vlajinac, H. Surgical site infections in orthopedic patients: prospective cohort study. Croat Med J 2008;49:58–65.CrossRefGoogle ScholarPubMed
Allegranzi, B, Bischoff, P, de Jonge, S, et al and the WHO Guidelines Development Group. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016;16:e276–e287.CrossRefGoogle ScholarPubMed
Greene, LR. Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide. Am J Infect Control 2012;40:384–386.CrossRefGoogle ScholarPubMed
Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999;27:97–132.CrossRefGoogle ScholarPubMed
Greene, LR, Mills, R, Moss, R, Sposato, K, Vignari, M. APIC guide to the elimination of orthopedic surgical site infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDe. Accessed November 23, 2020.Google Scholar
Sax, H, Allegranzi, I, Uçkay, E, Larson, E, Boyce, D, Pittet, D. ‘My Five Moments for Hand Hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.CrossRefGoogle ScholarPubMed
Infection control in the built environment—design and planning. National Health Services England website. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148493/HFN_30_-_Infection_control.pdf. Published 2002. Accessed November 23, 2020.Google Scholar
Reiling, J, Hughes, RG, Murphy, MR. The impact of facility design on patient safety. In: Hughes, RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google ScholarPubMed
Guide to the elimination of orthopedic surgical site infections. An APIC guide, 2010. Association for Professionals in Infection Control and Epidemiology website. https://apic.org/wp-content/uploads/2019/10/APIC-Ortho-Guide.pdf. Accessed November 23, 2020.Google Scholar
Campbell, KA, Stein, S, Looze, C, Bosco, JA. Antibiotic stewardship in orthopedic surgery: principles and practice. J Am Acad Orthop Surg 2014;22:772–781.CrossRefGoogle ScholarPubMed
Uckay, I, Berli, M, Sendi, P, Lipsky, BA. Principles and practice of antibiotic stewardship in the management of diabetic foot infections. Curr Opin Infect Dis 2019;32:95–101.CrossRefGoogle ScholarPubMed