Meng-Si Wu a, Tzong-Bor Sun a, e, Ming-Hwang Shyr b, e, Yu-Chi Wei c, e, Tsung-Ying Chen b, e, Tang-Yuan Chu c, e, Yu-Huai Ho d, e, Lih-Shinn Wang d, e
aDivision of Plastic Surgery, Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
bDepartment of Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
cDepartment of Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
dDepartment of Infectious Disease, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
eDepartment of Medicine, Tzu Chi University, Hualien, Taiwan
Abstract
Objective
To prevent surgical site infections, we conducted the Breakthrough Quality Improvement Project to optimize antimicrobial prophylaxis for abdominal hysterectomy. The specific aims were to increase the proportion of patients who receive prophylactic antimicrobial therapy within 1 hour prior to incision and increase the proportion of patients whose prophylactic antimicrobial therapy is discontinued within 24 hours after the end time of surgery.
Materials and Methods
The Breakthrough model was introduced by the Taiwan Joint Commission on Hospital Accreditation. It consisted of experts' meetings, learning sections and action periods with Plan-Do-StudyAct cycles. The control group included 43 patients undergoing abdominal hysterectomy and 29 patients were enrolled as the experimental group. Timing and duration of antimicrobial prophylaxis, incidence of surgical site infection, and hospital and antibiotic costs were recorded.
Results
The patients who followed the recommendations had no surgical site infections within 30 days after the end of surgery. Prophylaxis administration within 1 hour prior to incision was significantly increased from 69.3% to 92.4%. Prophylaxis duration of less than 24 hours was significantly increased from 25% to 100%. The length of hospital stay, hospital costs and antibiotic costs were all reduced.
Conclusion
We successfully introduced the Breakthrough Project to improve the quality of medical care through antimicrobial prophylaxis. By applying this important management model, we were able to optimize the timing and duration of antimicrobial prophylaxis in patients undergoing abdominal hysterectomy. Our experience demonstrates that this is one of the choices for effectively dealing with quality of medical care issues.
Keywords
Abdominal hysterectomy; Antibiotic prophylaxis; Breakthrough model; Quality of medical care; Taiwan Quality Indicator Project
