Quality Improvement of Antimicrobial Prophylaxis for Abdominal Hysterectomy in a Medical Center in Eastern 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

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