Application of PDCA cycle management in the rational use of perioperative antimicrobial prophylaxis in orthopedic clean surgery

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BACKGROUND: Optimal antimicrobial prophylaxis has been demonstrated to reduce the incidence of surgical site infections (SSIs). The PDCA cycle management approach has been extensively adopted in the healthcare industry. The objective of this study is to examine the impact of PDCA cycle management on the rational use of perioperative antimicrobial prophylaxis in orthopedic clean surgeries. METHODS: Following a thorough evaluation of the antibiotic prescription practices for patients undergoing orthopedic clean surgeries at the hospital during the initial three-month period of 2023, a series of pertinent measures were devised and initiated as a dynamic intervention from April 2023 to February 2024. The rationality of perioperative prophylactic antimicrobial use and clinical outcomes were compared before and after the intervention. RESULTS: The irrational use of perioperative prophylactic antibiotics was significantly reduced. It is mainly reflected in the utilization of surgical antibiotic prophylaxis [94.7% vs. 84.8%, p < 0.001, 95% CI (1.753,6.851)], inappropriate prophylaxis [68.7% vs. 47.3%, p < 0.001,95% CI (0.276,0.595)], unindicated prophylaxis [18.0% vs. 2.9%, p < 0.001,95% CI (0.045,0.273)], inappropriate drug selection [13.3% vs. 2.9%, p < 0.001, 95% CI (0.057,0.413)], and inappropriate intraoperative redosing [1.7% vs. 0%, p = 0.024,95% CI (0.964,0.996)]. In addition, the rate of inappropriate dosage [1.3% vs. 0%, p = 0.120, 95% CI (0.971,0.996)], inappropriate timing [3.9% vs. 1.7%, p = 0.146,95% CI (0.092,1.463)], and inappropriate postoperative antibiotic switching [0.4% vs. 0%, p = 0.494,95% CI (0.984,0.996)] were also decreased. However, the rate of inappropriate prophylaxis duration [42.1% vs. 42.3%, p = 0.965, 95% CI (0.680, 1.462)] and combination treatment [1.3% vs. 7.1%, p = 0.002, 95% CI (2.052, 23.292)] increased. With regard to clinical outcomes, the length of stay[15(10) to 13(7), p = 0.012, 95% CI(0.000,3.000)], hospitalization expenses[50244.96(53,376.00) to 41,539.92(31,809.94), p = 0.01, 95% CI (2157.160, 15,935.620)], medication costs[4326.215(3672.48) to 3272.17(2885.15), p < 0.001, 95% CI (498.170, 1745.440)], antibiotic costs [274.435(351.89) to 219.12(239.04), p = 0.004, 95% CI (19.920,119.520)], and other perioperative infections rates [46.3% to 26.4%, p < 0.001, 95% CI (1.427,4.090)] all decreased significantly after the intervention. CONCLUSION: The PDCA cycle management strategy was found to be an effective method of optimizing the rational use of perioperative prophylactic antibiotics and clinical outcomes in orthopedic clean surgeries. Nevertheless, this approach is encumbered by time-sensitive limitations, and its intervention effects are challenging to sustain over an extended period, thus necessitating further refinement.

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