HOSPITAL PRACTICE

CDC, CMS joining forces to prevent surgical infection

The Centers for Disease Control & Prevention is collaborating with the Centers for Medicare & Medicaid Services (CMS) to develop a healthcare quality improvement project to prevent postsurgical infection. In August 2002, CDC and CMS will initiate the project, called the Surgical Infection Prevention Project (SIPP), on a national level.

Improving the selection and timing of prophylactic antibiotic administration is the goal of SIPP. The project will focus on different surgeries, including coronary artery bypass graft, cardiac surgery, colon surgery, hip and knee arthroplasty, abdominal and vaginal hysterectomy, and certain vascular procedures.

The project is being administered by the Oklahoma Foundation for Medical Quality (OFMQ). The project Web site, found at www.surgicalinfectionprevention.org, reports that members of CMS, CDC, and the Infectious Diseases Quality Improvement Organization Support Center of OFMQ meet monthly to serve as the project's steering committee. A panel of experts consisting of members of the steering committee and of national medical organizations, including the American College of Surgeons, also meets monthly. The purpose of this panel is to advise the steering committee on matters such as operations and procedures, as well as quality indicators.

Proposed indicators that focus on antibiotic selection and the timing of antibiotic administration have been developed by the panel. As listed on the Web site, these preliminary quality indicators are:

• The proportion of patients who were given antibiotic therapy in a manner consistent with current guidelines

• The proportion of patients who received antibiotic prophylaxis within the hour prior to surgical incision

• The proportion of patients whose prophylactic antibiotics were discontinued within 24 hours after surgery.

The panel also plans to develop recommendations for anti-biotic therapy and is reviewing current relevant guidelines.

Keith Olson, Pharm.D., associate professor of pharmacy, University of Nebraska Medical Center, Omaha, said the role of the pharmacist in the prevention and management of surgical infection is multifactorial. He feels R.Ph.s can play an integral role in the selection of the proper antibiotic and the timing and duration of antibiotic therapy.

"Pharmacists can be leaders of multidisciplinary teams that identify the problems surrounding surgical prophylaxis and antibiotic resistance," Olson said. "Pharmacists can serve as liaisons among the surgeon, the laboratory, and infection control."

Administration of an antibiotic shortly before surgery is critical to effective prophylaxis, said Peter Houck, M.D., government task leader, National Surgical Infection Prevention Project, CMS Region X Office, Seattle. Pharmacists can play an important role in getting the appropriate drug to the appropriate patient on time. Patients must receive antibiotics not too close to the time of surgery, but not after surgery has started. Houck and Olson concur that pharmacists can meet this need because they are the most familiar with the antibiotic delivery system in their hospital.

According to Dale Bratzler, D.O., M.P.H., principal clinical coordinator, OFMQ, pharmacists can help hospitals get antibiotic delivery systems into place, so that the drug delivery process is standardized. He said patients in hospitals involved in local surgical infection prevention projects were receiving a broad vari-ety of antibiotics, none of which were pharmacologically appropriate for preventing wound infections. "Pharmacists helped come up with standardized protocols for appropriately selecting antibiotics to prevent surgical infection. These efforts reduced the variation among the antibiotics given to patients undergoing elective surgery," he said.

Houck feels that the duration of antibiotic therapy is an important area on which pharmacists can focus their attention. The duration of therapy is very important because of issues such as cost and the risks inherent with unnecessary antibiotic therapy, such as Clostridium difficile infection and antibiotic resistance. It has been shown that a short course of treatment is equally as efficacious as a longer course of treatment, he said.

CMS has had several experiences demonstrating that pharmacists can influence the way physicians practice. As members of antibiotic management teams, R.Ph.s can make physicians aware of patients who are receiving inappropriate antibiotic therapy, in terms of the specific drug being administered or the duration of treatment recommended, Houck said. They can then make suggestions to protect the patient from adverse events, prevent antimicrobial resistance among the bacteria circulating in the particular patient and among those circulating in the hospital, and save the hospital money on antibiotics, he concluded.

Charlotte LoBuono

Charlotte LoBuono. CDC, CMS joining forces to prevent surgical infection.

Drug Topics

2002;11:29.