JCAHO Update for Infection Control: JCAHO looking at timing of surgical drug prophylaxis

Research may lead to new quality indicators

The Joint Commission on Accreditation of Healthcare Organizations is partnering with the University of Tennessee, the Centers for Disease Control and Prevention, and the Society for Healthcare Epidemiology of America to conduct a four-year study under an Agency for Healthcare Quality and Research-funded grant project entitled "Trial to Reduce Antibiotic Prophylaxis Errors" (TRAPE). The study will examine hospitals’ timely use of antibiotics before and after cardiovascular, joint replacement, and hysterectomy surgeries to effectively reduce post-surgical infection.

It is estimated from one-third to one-half of surgical patients do not receive antibiotics or receive them in such a way as to leave them relatively unprotected from infection, says principal investigator Stephen B. Kritchevsky, PhD, professor of the department of preventive medicine at the University of Tennessee in Knoxville.

"If you split the difference, about 35% or 40% of patients are getting suboptimal prophylaxis," he says. "It is quite widespread. Most antibiotics should be given about an hour before surgery. If they are given before that or after the incision, it is really not optimal. So [this study] is really a process’ focus — here’s a target, that if people could hit, patient care quality would be improved. What is stopping people from hitting this target and what can they do to do a better job?"

As ICPs are well aware, post-surgical infections can lead to readmission, extended hospital stays and even death. "Patients who don’t get prophylaxis or get it very late are somewhere on the order of four to six times more likely to get infections," Kritchevsky says.

The study will start early this year, as 40 hospitals will enroll in the randomized trial for six months. Half of the hospitals will receive feedback on their error rates. The other half will receive feedback plus intensive assistance in identifying and implementing solutions to improve the appropriateness and timeliness of preventive antibiotics. While 20 hospitals will only get baseline and summary information, another 20 selected at random will receive much more detailed feedback.

"We have a few interventions — innovations, we hope — that we are trying to validate," says Kritchevsky. "We will be doing a process assessment of how each of the hospitals in our study provide antibiotic prophylaxis. We’ll relate that to the timing problems and hopefully identify a list of best practices."

The Joint Commission is serving as coordinator of the study, but is participating through its research — as opposed to regulatory — branch. That means, essentially, that the study is not being done with an eye on changing Joint Commission requirements, though that could be the result somewhere down the road.